Serdar AYKAN, Mustafa Zafer TEMİZ MD, Yılmaz MEHMET, Emrah YAKUT, Atilla SEMERCİÖZ, Yaser Ahmet 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.

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.

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