Ulaş ADAY, Abdullah BÖYÜK

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 surgical management of recurrent cysts associated with procedure-related spillage, the procedure is further complicated by the multifocal nature of these cysts and the adhesions caused by prior surgery, thereby leading to increased risk of morbidity and recurrence. There fore, utmost care should be taken to prevent spillage during the primary surgery. In this report, we present a 64-year-old female patient who underwent surgical treatment due to multifocal, symptomatic, recurrent hydatid cysts associated with procedure-related spillage. Total cystectomy was performed for the cysts in the abdominal wall and in the intraabdominal and subdiaphragmatic areas while partial cystectomy with drainage and omentoplasty were performed for the cysts in the liver parenchyma. The recurrence risk can be reduced via perioperative albendazole treatment, complete resection of the cyst without perforation, protection of adjacent anatomical structures by the use of scolicidal agent-soaked sponges, and meticulous surgical treatment leaving no residual cyst material.

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.

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