Gasless vs gaseous laparoscopy in the treatment of hepatic hydatid disease

Despite the reduced rate of occurrence, the hydatidosis of the liver is still taking an important place in surgical practice in Asia Minor and the Middle East. Traditional techniques for performing liver cyst surgery seem to be comparatively traumatic. In this clinical study, we present our experience with laparoscopic treatment of hydatid cyst of the liver and discuss the validity of the gasless technique as a solution to carbon dioxide (CO(2)) ensufflation problems.

All patients were prepared by administering albendazole for 21 days preoperatively. Surgery was performed on 87 patients under general anesthesia. Working space was obtained in 51 operations by using an abdominal wall lifting device, Laparolift (Origin Med Systems, Menlo Park, California, USA) (group 1). In 36 patients, the abdominal cavity was insufflated with CO(2) gas (group 2). In all cases, hydatid cysts were identified, and gauze soaked in germicide solution were placed around them. The cysts were punctured and aspirated. Then germisid solution was injected into the cysts. The cysts walls were opened, and germinative membranes were evacuated.

The median operation time was 50.49 +/- 10.9 min (range, 30-75 min) in group 1 and 70.8 +/- 16 min (ranges 40-120 min) in group 2. The difference in the operative times of the two groups was significant (p < 0.01). There was no significant difference between the minor complications of the two groups. There were no deaths and no major complications or conversions to open surgery in any of the groups. There were no recurrences during follow-up time.

The use of gasless technique for the laparoscopic treatment of liver cyst is a safe, time-saving, and promising procedure that can be applied in selected cases.