[Laparoscopic management of echinococcal cysts of the liver]

Even though echinococcal cysts have been cured by puncture and instillation of scolicidal medications, surgery is still the mainstay of the treatment of hydatid disease. The aim of the surgical treatment is the elimination of scolices, the removal of all viable parts of the cyst and the obliteration of the remaining cavity. This can be achieved by resective procedures, but also by a more conservative approach with drainage and obliteration of the cyst. The latter procedure can be done by open surgery or laparoscopically. The disadvantages of the laparoscopic approach are the increased danger of contamination of the abdominal cavity with scolices and difficulties to aspirate a highly viscous cyst content. Furthermore, cysts which are located deep in the parenchyma of the liver should not be approached laparoscopically because of the significant danger of hemorrhage. The advantage of the laparoscopic approach in selected cysts, i.e. those which are located superficially and having a liquid content, are a shorter hospital stay, lower incidence of wound infection and the ability of the surgeon to inspect the inside of the cyst more thoroughly and rule out daughter cysts and connections to the biliary tract. A review of the literature (n = 76) indicates that in most laparoscopically treated hydatid cysts of the liver a simple drainage (59%) or an unroofing (31%) is performed. The complication rate is 21%. Because there are no longterm observations after laparoscopic operations for hydatid disease the question of recurrence cannot yet be answered.