Karaciğer hidatik kist cerrahisinde dökülme ve nüks

Tedavi modalitelerindeki gelişmelere rağmen kist hidatik hastalığında nüks önemini korumaktadır. Konservatif cerrahi esnasında kist elamanlarının dökülmesi (spillage) extrahepatikmultifokalnükslerle sonuçlanabilir. Nüks vakalarda adezyonlar ve multifokal kistler nedeniyle cerrahi prosedür kompleksleşir, morbidite ve nüks oranları artar. Bu nedenle primer cerrahi esnasında dökülmelerin önlenmesine yönelik tüm tedbirler alınmalıdır. Altmış dört yaşında kadın hastada spillage nedeniyle gelişen multifokal, semptomatiknükshidatik kist nedeniyle cerrahi tedavi uygulandı. Abdominal duvar, intrabdominal, subdiafragmatik kistlere total kistektomi, karaciğerdeki kiste parasiyelkistektomi+drenaj+omentoplasti yapıldı. Perioperatifalbendazol kullanımı, kistte rüptüroluşturulmaması, cerrahi alanın skolosidal ajanlarca korumaya alınması ve rezidü kist elamanlarının bırakılmaması nüks gelişimini önlemede oldukça önemlidir.

Spillage and recurrence in surgical management of hydatid cyst of the liver

Recurrence remains a serious problem in hydatid disease (HD) despite the advancements in treatment modalities.Spillage of cyst material during conservative treatment can result in extrahepatic multifocal recurrence. In the surgicalmanagement of recurrent cysts associated with procedure-related spillage, the procedure is further complicated bythe multifocal nature of these cysts and the adhesions caused by prior surgery, thereby leading to increased risk ofmorbidity and recurrence.There fore, utmost care should be taken to prevent spillage during the primary surgery. In this report, we present a64-year-old female patient who underwent surgical treatment due to multifocal, symptomatic, recurrent hydatid cystsassociated with procedure-related spillage. Total cystectomy was performed for the cysts in the abdominal wall and inthe intraabdominal and subdiaphragmatic areas while partial cystectomy with drainage and omentoplasty wereperformed for the cysts in the liver parenchyma.The recurrence risk can be reduced via perioperative albendazole treatment, complete resection of the cyst withoutperforation, protection of adjacent anatomical structures by the use of scolicidal agent-soaked sponges, andmeticulous surgical treatment leaving no residual cyst material.

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1. Bahce ZS, Akbulut S, Aday U, Demircan F, Senol A. Cutaneous fistulization of the hydatid disease: A PRISMA-compliant systematic review. Medicine. 2016; 95: .
2. Brunetti E, Kern P, Vuitton DA. Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010; 114: 1–16.
3. Sielaff TD, Taylor B, Langer B. Recurrence of hydatid disease. World J Surg. 2001; 25: 83–6.
4. Jerraya H, Khalfallah M, Osman SB, Nouira R, Dziri C. Predictive factors of recurrence after surgical treatment for liver hydatid cyst. SurgEndosc. 2015; 29: 86-93.
5. Velasco-Tirado V, Romero-Alegría Á, BelhassenGarcía M, et all. Recurrence of cystic echinococcosis in an endemic area: a retrospective study. BMC Infect Dis. 2017; 17: 455.
6. Kapan M, Kapan S, Goksoy E, Perek S, Kol E. Postoperative recurrence in hepatic hydatid disease. J Gastrointest Surg 2006; 10: 734–9.
7. E Malki HO, E Mejdoubi Y, Souadka A, et all. Does primary surgical management of liver hydatid cyst influence recurrence?. J Gastrointest Surg. 2010; 14: 1121-27.
8. Aydin U, Yazici P, Onen Z, et all. The optimal treatment of hydatid cyst of the liver: radical surgery with a significant reduced risk of recurrence. Turk J Gastroenterol. 2008; 19:33-9.
9. Malik A. A, ul Bari S. Surgical Management of Hydatid Liver Disease. In Human Abdominal Hydatidosis. Springer, Singapore. 2019; 37-54.
10. Prousalidis J, Kosmidis C, Anthimidis G, et all. Postoperative recurrence of cystic hydatidosis. Can J Surg. 2012; 55: 15-20.
11. Arif SH, Shams-U-Bari, Wani NA, et all. Albendazole as an adjuvant to the standard surgical management of hydatid cyst liver. Int J Surg 2008; 6: 448–51.