[Laparoscopic surgery for hepatic hydatid cyst--possibilities and limitations]

Laparoscopy in hydatid liver disease, is not addressing only to simple but to complicated cases, although the rate of complications registered a significant decrease because of the modem means (ultrasonography, TC) and the precocity of the diagnostic. We made a retrospective study on 76 patients with liver hydatid cysts admitted and operated in two Surgery Clinics of Sibiu and Braila, between January 2002 and January 2007. On 52 cases we performed laparoscopic interventions and 24 where operated in open surgery, decided by the option and the experience of the surgeon. Our laparoscopic technique is based on specific and original instruments, two patented inventions which increase the security of the primary approach of the liver hydatid cyst. This specific set of instruments, uses extraperitoneal work tunnels for treatment and exploration inside the cyst. The limits of laparoscopy are represented by the cases which presume difficulties and require the conversion. We had one patient who needed conversion to open surgery with a "mercedes" incision, because of the huges dimensions of the liver cyst (25 cm), which did not allowed the induction of a suitable work camera, and because of it's central position (IV-V-VI segments) and numerous adherences to adjacent organs. At three or our cases, the cyst position and the peri-cystic adherences, required the cysto-phrenic dissection, ended with diaphragm perforation, solved by laparoscopic suture without thoracic drainage, but with intra-operatory aspiration of the pneumothorax. The advantages of the laparoscopy are numerous, from the excellent visibility inside abdomen and inside the hydatid cyst cavity, the protection of the abdominal wall and peritoneal cavity, to a relevant shortening of hospitalisation period and convalescence.