Laparoscopic management of Hepatic cystic echinococcosis in Nepal: A single center experience

Introduction: Advances in laparoscopy has replaced many conventional open surgeries; hepatic cystic echinococcosis (CE) surgery is no exception. This study aims to evaluate the feasibility, postoperative outcomes including complications and recurrence rates after employing laparoscopic treatment fo...

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Autores principales:	Rabin Koirala, Ashish P. Rajbhandari, Shailesh Maharjan, Sashi Shekhar Adhikari
Formato:	article
Lenguaje:	EN
Publicado:	Society of Surgeons of Nepal 2020
Materias:	Cystic echinococcosis Hydatid cyst Laparoscopic surgery Partial pericystectomy Surgery RD1-811
Acceso en línea:	https://doaj.org/article/06ea479bdf1a4fd0b7af4416704a1975
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spelling	oai:doaj.org-article:06ea479bdf1a4fd0b7af4416704a19752021-12-05T19:15:43ZLaparoscopic management of Hepatic cystic echinococcosis in Nepal: A single center experience10.3126/jssn.v23i1.335131815-39842392-4772https://doaj.org/article/06ea479bdf1a4fd0b7af4416704a19752020-12-01T00:00:00Zhttps://www.nepjol.info/index.php/JSSN/article/view/33513https://doaj.org/toc/1815-3984https://doaj.org/toc/2392-4772 Introduction: Advances in laparoscopy has replaced many conventional open surgeries; hepatic cystic echinococcosis (CE) surgery is no exception. This study aims to evaluate the feasibility, postoperative outcomes including complications and recurrence rates after employing laparoscopic treatment for hepatic CE. Methods: This is a prospective study involving patients who underwent laparoscopic intervention for Hepatic CE at Nepal Medical College and Teaching Hospital from 1st July 2014 to 30th June 2019. Laparoscopic partial pericystectomy was done through the Palanivelu hydatid system and technique after pretreatment with albendazole (10mg/kg) for at least one week. Clavien-Dindo classification was used to classify postoperative complications. Results: Twenty-two patients were enrolled in the study with a mean age of 33.95±15.24 (18.0-75.0) years, 15 (68.18%) of them being female. Abdominal pain (77.3%) was the commonest complaint and a single cyst in the right lobe of the liver was the commonest pathology. The mean size of the cyst was 10.2±3.0 (5.0-15.0) cms. 40.9% of the cysts belonged to WHO-IWGE Grade CE3, while grade CE2 and CE1 consisted of 27.3% each. The mean operation time was 80.7 ± 19.7 (60-120) minutes. Out of the 22 patients, six (27.3%) had minor grades while four (18.2%) had major grades of Clavien-Dindo complications. Among the major complications, one (4.5%) patient each developed biliary fistula managed with ERCP and stenting, recurrence after three months, intraoperative bleeding requiring conversion to open surgery, and acute kidney injury managed with dialysis. There was no anaphylaxis or operative mortality. Conclusion: In selected patients, laparoscopic treatment for hepatic CE is feasible even in a resource-limited country like Nepal. With a low rate of conversion, recurrence and mortality, laparoscopic management can be safe, effective and encouraging treatment modality for the patients of hepatic CE. Rabin KoiralaAshish P. RajbhandariShailesh MaharjanSashi Shekhar AdhikariSociety of Surgeons of NepalarticleCystic echinococcosisHydatid cystLaparoscopic surgeryPartial pericystectomySurgeryRD1-811ENJournal of Society of Surgeons of Nepal, Vol 23, Iss 1 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cystic echinococcosis Hydatid cyst Laparoscopic surgery Partial pericystectomy Surgery RD1-811
spellingShingle	Cystic echinococcosis Hydatid cyst Laparoscopic surgery Partial pericystectomy Surgery RD1-811 Rabin Koirala Ashish P. Rajbhandari Shailesh Maharjan Sashi Shekhar Adhikari Laparoscopic management of Hepatic cystic echinococcosis in Nepal: A single center experience
description	Introduction: Advances in laparoscopy has replaced many conventional open surgeries; hepatic cystic echinococcosis (CE) surgery is no exception. This study aims to evaluate the feasibility, postoperative outcomes including complications and recurrence rates after employing laparoscopic treatment for hepatic CE. Methods: This is a prospective study involving patients who underwent laparoscopic intervention for Hepatic CE at Nepal Medical College and Teaching Hospital from 1st July 2014 to 30th June 2019. Laparoscopic partial pericystectomy was done through the Palanivelu hydatid system and technique after pretreatment with albendazole (10mg/kg) for at least one week. Clavien-Dindo classification was used to classify postoperative complications. Results: Twenty-two patients were enrolled in the study with a mean age of 33.95±15.24 (18.0-75.0) years, 15 (68.18%) of them being female. Abdominal pain (77.3%) was the commonest complaint and a single cyst in the right lobe of the liver was the commonest pathology. The mean size of the cyst was 10.2±3.0 (5.0-15.0) cms. 40.9% of the cysts belonged to WHO-IWGE Grade CE3, while grade CE2 and CE1 consisted of 27.3% each. The mean operation time was 80.7 ± 19.7 (60-120) minutes. Out of the 22 patients, six (27.3%) had minor grades while four (18.2%) had major grades of Clavien-Dindo complications. Among the major complications, one (4.5%) patient each developed biliary fistula managed with ERCP and stenting, recurrence after three months, intraoperative bleeding requiring conversion to open surgery, and acute kidney injury managed with dialysis. There was no anaphylaxis or operative mortality. Conclusion: In selected patients, laparoscopic treatment for hepatic CE is feasible even in a resource-limited country like Nepal. With a low rate of conversion, recurrence and mortality, laparoscopic management can be safe, effective and encouraging treatment modality for the patients of hepatic CE.
format	article
author	Rabin Koirala Ashish P. Rajbhandari Shailesh Maharjan Sashi Shekhar Adhikari
author_facet	Rabin Koirala Ashish P. Rajbhandari Shailesh Maharjan Sashi Shekhar Adhikari
author_sort	Rabin Koirala
title	Laparoscopic management of Hepatic cystic echinococcosis in Nepal: A single center experience
title_short	Laparoscopic management of Hepatic cystic echinococcosis in Nepal: A single center experience
title_full	Laparoscopic management of Hepatic cystic echinococcosis in Nepal: A single center experience
title_fullStr	Laparoscopic management of Hepatic cystic echinococcosis in Nepal: A single center experience
title_full_unstemmed	Laparoscopic management of Hepatic cystic echinococcosis in Nepal: A single center experience
title_sort	laparoscopic management of hepatic cystic echinococcosis in nepal: a single center experience
publisher	Society of Surgeons of Nepal
publishDate	2020
url	https://doaj.org/article/06ea479bdf1a4fd0b7af4416704a1975
work_keys_str_mv	AT rabinkoirala laparoscopicmanagementofhepaticcysticechinococcosisinnepalasinglecenterexperience AT ashishprajbhandari laparoscopicmanagementofhepaticcysticechinococcosisinnepalasinglecenterexperience AT shaileshmaharjan laparoscopicmanagementofhepaticcysticechinococcosisinnepalasinglecenterexperience AT sashishekharadhikari laparoscopicmanagementofhepaticcysticechinococcosisinnepalasinglecenterexperience
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Laparoscopic management of Hepatic cystic echinococcosis in Nepal: A single center experience

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