Serdar AYKAN, Mustafa Zafer TEMİZ, Mehmet YILMAZ, Emrah YAKUT, Atilla SEMERCİOZ, Ahmet Yaser MÜSLÜMANOĞLU

Renal Kist Hidatik Tedavisinde Laparoskopik Transperitoneal Yaklaşımın Etkinlik ve Güvenirliğinin Değerlendirilmesi

Amaç: Ekinokok enfeksiyonu başta endemik bölgeler olmak üzere Dünya genelinde yaygın olarak görülebilen bir parazitoz olmasına rağmen izole renal tutulumlu kist hidatik olgusuna nadiren rastlanılmaktadır. Bu olgu serimizde laparoskopik transperitoneal yaklaşımla tedavi edilen izole renal kist hidatik olgularında laparoskopik yaklaşımın sonuçlarını irdelemeyi amaçladık. Gereç ve Yöntemler: Mayıs 2011 ve Temmuz 2017 arası kliniğimizde izole renal kist hidatik tanılı 4 hastaya perioperatif kist içeriği aspirasyonu ve hipertonik salin infüzyonuyla birlikte endokistlerin tamamen aspirasyonunu takiben laparoskopik transperitoneal kistektomi uygulandı. Tüm hastalarda profilaktik ve adjuvan medikal tedavi ajanı olarak albendazol uygulandı. Operasyon sonuçları ve hastaların operasyon öncesi ve sonrası indirekt hemaglütinasyon testi (İHA) titreleri ile radyolojik görüntülemede saptanan kist boyutlarındaki değişimler incelendi. Bulgular: Transperitoneal laparoskopik yaklaşım tüm olgularda sorunsuzca tamamlandı. Ortalama operasyon süresi ve kan kaybı 135 ± 45 dk ve 157.6 ± 80 ml saptandı. Median 24 ay takip sonrası ortalama operasyon öncesi ve sonrası İHA titreleri istatistiksel olarak anlamlı değişim göstermezken (133.3 ± 46 vs 213 ± 369.5, P=0.06), ortalama kist çapında anlamlı derecede azalma (62.53 ± 45.51 mm vs 28.3 ± 25.65 mm, P= 0.001) saptandı. Sonuç: Renal kist hidatik tedavisinde transperitoneal laparoskopik yaklaşım güvenli ve etkin bir yöntem olup profilaktik ve /veya adjuvan medikal tedaviyle birlikte seçili olgularda güvenle uygulanabilir.

Anahtar Kelimeler:

Laparoskopi, Kist Hidatik, Böbrek

Assessment of the Safety and Feasibility of Transperitoneal Laparoscopic Treatment for Renal Cyst Hydatid Disease

Objective: Although Echinococcosis is a common parasitic disease especially in endemic regions with a worldwide dissemination, isolated renal echinococcosis is relatively uncommon compared to liver and lung localizations. In this case study, we aimed to determine the safety and feasibility of transperitoneal laparoscopic treatment for renal cyst hydatid disease. Material and Methods: A total of 4 patients with isolated renal cyst hydatid underwent transperitoneal laparoscopic treatment with excision of the cyst after aspiration of cyst content and hypertonic serum saline injection between May 2011-July 2017 were retrospectively evaluated. Albendazol treatment was applied all of the patients as prophylactic and adjuvant medical therapy. Surgical outcomes and changes in indirect hemagglutination (IHA) titre levels with cyst diameters after the surgery were determined and compared. Results: Transperitoneal laparoscopic surgery were performed successfully in all cases without any complications. Mean operative time and mean estimated blood loss were 135 ± 45 min. and 157.6 ± 80 ml, respectively. While mean IHA titre level did not significantly change after the surgery (133.3 ± 46 vs 213 ± 369.5, P=0.06), mean cyst diameter was significantly reduced after the surgery (62.53 ± 45.51 mm vs 28.3 ± 25.65 mm, P= 0.001). Conclusion: Transperitoneal laparoscopic treatment is a safe and feasible surgical method for renal cyst hydatid with prophylactic and/or adjuvant medical treatment in selected cases.

Keywords:

Laparoscopy, cyst hydatid, kidney,

PDF

___

1. Sayek I, Tirnaksiz MB, Dogan R. Cystic hydatid disease: current trends in diagnosis and management. Surg Today 2004; 34:987-96.
2. Köktürk O, Gürüz Y,Akay H Akhan O, Biber Ç, Çağırıcı U ve ark. Toraks Derneği Paraziter Akciğer Hastalıkları Tanı ve Tedavi Rehberi Toraks Dergisi 2002; 3: 1-16.
3. Derfoufi O, Ngoh Akwa E, Elmaataoui A, et al. Epidemiological profile of cystic echinococcosis in Morocco from 1980 to 2008. Ann Biol Clin (Paris) 2012; 170: 457-61.
4. Warren D, Johnson JR, Christopher W, et al. Parasitic disease of the genitourinary system. In: Walsh PC, Retik AB, Vaughan FD, eds. Campbell’s Urology, vol 2, 8th ed. Philadelphia: Elsevier Saunders 2002:786-788.
5. Rabii R, Mezzour MH, Essaki H, et al. Laparoscopic treatment for renal hydatid cyst. J Endourology 2006;20:199-201.
6. Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010;114:1-16.
7. D.P. McManus, W. Zhang, J. Li, P.B. Bartley. Echinococcosis. Lancet 362 (2003), pp. 1295-1304.
8. Gogus C, Safak M, Baltaci S, Turkolmez K. Isolated renal hydatidosis: experience with 20 cases. J Urol 2003;169:186–9.
9. Angulo JC, Sanchez-Chapado M, Diego A, Escribano J, Tamayo JC, Martin L. Renal echinococcosis: clinical study of 34 cases. J Urol 1997;157:787e94.
10. Shahait M, Saoud R, Hajj AE. Laparoscopic treatment of giant renal cystic echinococcosis. International Journal of Infectious Diseases. Volume 42, January 2016, Pages 58-60.
11. Vargus-Serrano B, Ferreiro-Argüelles C, Rodríguez-Romero R, Marcos del Río N. Imaging findings in renal hydatid disease. Eur Radiol 1997; 7: 548-51.
12. Giovanni Aprea, Sergio Aloia, Gennaro Quarto et al. Uncommon primary hydatid cyst occupying the adrenal gland space, treated with laparoscopic surgical approach in an old patient. Open Med 2016; 11: 413-417.
13. Pedro Moro, Peter M. Schantz. Echinococcosis: a review. International Journal of Infectious Diseases 2009;13: 125-133.
14. Tryfonas GJ, Avtzoglou PP, Chaidos C, Zioutis J, Gavopoulos S, Limas C. Renal hydatid disease: diagnosis and treatment. J Pediatr Surg 1993;28:228–231.
15. Zmerli S, Ayed M, Horchani A, Chami I, El Ouakdi M, Ben Slama MR. Hydatid cyst of the kidney: diagnosis and treatment. World J Surg 2001;25:68–74.
16. Ozden E, Bostanci Y, Mercimek MN, Yakupoglu YK, Yilmaz AF, Sarıkaya S. Renal hydatid cyst treatment: retroperitoneoscopic “closed cyst” pericystectomy. Int J Urol 2011;18:237–239.
17. Shah KJ, Ganpule AP, Desai MR. Isolated renal hydatid cyst managed by laparoscopic transperitoneal nephrectomy. Indian J Urol 2009;25:531–53.
18. Divarci E, Ulman I, Avanoglu A. Retroperitoneoscopic laparoscopic treatment of renal hydatid cyst in a child. J Pediatr Surg 2010;45:262–264.
19. Khan M, Sajjad Nazir S, Ahangar S, Farooq Qadri SJ, Ahmad Salroo N. Retroperitoneal laparoscopy for the management of renal hydatid cyst. Int J Surg 2010;8:266–268.
20. Bickel A, Daud G, Urbach D, et al. Laparoscopic approach to hydatid liver cysts: is it logical? Physical, experimental, and practical aspects. Surg Endosc 1998;12:1073-7.
21. A Ksiaa, H Zitouni, A Zrig, Y Kerkeni, et al. Video-assisted surgery in the management of hydatid renal cyst in children. Journal of pediatric surgery. May 2013Volume 48, Issue 5, Pages e17–e19.
22. Beyribey S, Cetinkaya M, Adsan O, et al. Treatment of renal hydatid disease by pedicled omentoplasty. J Urol 1995;154:25–27.
23. Kumar S, Pandya S, Agarwal S, Lal A. Laparoscopic management of genitourinary hydatid cyst disease. J Endourol 2008;22:1709–1713.
24. Prabhudessai SC, Patankar RV, Bradoo A. Laparoscopic treatment of renal hydatid cyst. J Minim Access Surg 2009;5:20–21.
25. Aggarwal S, Bansal A. Laparoscopic management of renal hydatid cyst. JSLS. 2014 Apr-Jun;18(2):361-6. doi: 10.4293/10 8680813X13753907291396. Review.