[Minimally invasive surgery for liver echinococcosis]

To analyze the effectiveness of minimally invasive surgery for small and medium sized liver cysts.

We used minimally invasive technologies in 331 patients with echinococcal liver cysts (small cysts (<3.5 cm) - 49 (14.8%) cases, medium (3.5-7.0 cm) - 196 (59.2%), large (> 7.0 cm) - 86 (25.9%) cases). Conservative treatment was performed in 51 (15.4%) cases, percutaneous puncture treatment (PAIR, D - PA1 and PEVAK) combined with drug therapy - in 32 (9.7%), puncture and external drainage - in 90 (27.2%), open echinococcectomy via minimally invasive access - in 46 (13.9 %), cyst aplatization - in 57 (17.2%) cases. Minimally invasive resection technology was used in 55 (16.6%) patients.

Disappearance or scarring of cysts, shrinkage or structural change with complete resorption of liquid component were noted in 13 (25.5%) patients, no significant structural changes in the cyst (up to 3.5 cm) - in 27 (52.9%). Allergic manifestations occurred in 4 (12.5%) cases, complete regression of cyst - in 27 (84.4%), signs of suppuration - in 3 (9.4%), postoperative cystobiliary fistula - in 12 (13.3%) patients. Nine (10.0%) patients required cystpericystectomy via minimally invasive access. In cyst aplatization, conversion to mini-laparotomy took place in 2 (3.5%) cases, re-arrangement of ports - in 3 (5.3%), bile discharge through the drainage tube - in 2 (3.5%) cases. In resection technologies (n=55), re-arrangement of ports was necessary in 3 (5.4%) cases, intraoperative complications occurred in 3 (5.4%) cases, bleeding - in 3 (5.4%) patients. Postoperative specific complications were noted in 4 (7.3%) cases. Complications Clavien-Dindo type I were noted in 19 (55.8%) cases, type II - 1 (2.9%), IIIA - 5 (14.7%), IIIB - 9 (26.5%) cases. There were adverse events type IV and V. Recurrence of disease was observed in 27 (8.2%) patients.

One-stage total or subtotal echinococcectomy is the most effective surgery. Minimally invasive technologies are preferable for small and medium sized echinococcal liver cysts.