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INTRODUCTION

SURGICAL TREATMENT OF LARGE LIVER HYDATIDOSIS – A COMPARISON OF DIFFERENT PROCEDURES Dr. Avdyl Krasniqi – Kosova( Prishtina ) Dr. Viktor QERESHNIKU – Albania ( Tirana ) E bp.

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INTRODUCTION

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  1. SURGICAL TREATMENT OF LARGE LIVER HYDATIDOSIS – A COMPARISON OF DIFFERENT PROCEDURESDr. Avdyl Krasniqi – Kosova( Prishtina )Dr. Viktor QERESHNIKU – Albania ( Tirana ) E bp. A.Krasniqi¹, V. Qereshniku², B. Elezi ² , D. Limani ¹, F. Hoxha ¹,, A. Beqiri ², B. Bicaj ¹, A. Gjata ² , R. Musa ¹, S. Agolli ² , G. Spahija ¹, A. Kerciku ² , S. Krasniqi³, L. Gashi-Luci ³ ¹University Clinical Centre of Kosova, Prishtina, Kosovo ² University Hospital Centre “Mother Theresa”, Tirana, Albania ³ University of Prishtina,Faculty of Medicine, Prishtina, Kosovo 18th IASGO Congress - Istanbul, October 8-11, 2008

  2. INTRODUCTION 18th IASGO Congress - Istanbul, October 8-11, 2008

  3. INTRODUCTION • Liver hydatidosis has been a common pathology for years in the surgical departments of our hospitals; • Surgery combined with scolicidal therapy is the most often used treatment modality; • Mainly treated large liver hydatid cysts of: • Different topographic locations (T)¹ • Different levels of complication (C1-C6) • ¹Kjosev KT, Losanoff JE: J Gastroenterol Hepatol. 2005;20:352-9 18th IASGO Congress - Istanbul, October 8-11, 2008

  4. INTRODUCTION • Although concept of management of liver hydatidosis is changing, surgery is still gold standard for complete cure² • There is still contraversy regarding the appropriate surgical technique³ • Open surgical procedures: • Tissue sparing techniques; endocystectomies/partial pericystectomy • Radical procedures; complete pericystectomy/resection • ²Dervenis et al.:Journal of Gastrointestinal Surgery 2005;9:869-877. • ³Skroubis et.: World Journal of Surgery 2002;26:704-708. 18th IASGO Congress - Istanbul, October 8-11, 2008

  5. OBJECTIVE • To analyze the outcome of different surgical procedures that were used for treatment of 545 patients with large liver hydatid cysts. 18th IASGO Congress - Istanbul, October 8-11, 2008

  6. MATERIAL AND METHODS • A retrospective study • Chart review of patients with large liver hydatid cysts treated surgically over 15 years period in two university hospitals with almost similar settings in terms of patients, hospital resources and surgical teams: • University Clinical Centre of Kosova (UCKK) in Prishtina • University Hospital Centre “Mother Theresa” in Tirana (UHCT), Albania 18th IASGO Congress - Istanbul, October 8-11, 2008

  7. MATERIAL AND METHODS LARGE CYSTSPreoperative US/CT diameter < 12 cm;Different CE stages; WHO/Gharbi Classif. 18th IASGO Congress - Istanbul, October 8-11, 2008

  8. PATIENTS Total 545 Goup I 293 (UCCK - Prishtina Female 182 (62.08%) Male 111 (37.92%) F:M = 1.63:1 Group II 252 (UHC – Tirana) Age Median 37 years (Range 17-81) 20-40 range most often attacked MATERIAL AND METHODS 18th IASGO Congress - Istanbul, October 8-11, 2008

  9. Choice of procedure depends from: Size of the cyst Localization Intrabiliary communication Age Equipment Surgical team TREATMENT – FOLLOWED PRINCIPLES 18th IASGO Congress - Istanbul, October 8-11, 2008

  10. TREATMENT – FOLLOWED PRINCIPLES • Intraoperative intences: • - Adhesion dissection/ freed the cyst from other organs; • - Prevention of intraperitoneal spillover and intracystic scolicidal therapy; 18th IASGO Congress - Istanbul, October 8-11, 2008

  11. TREATMENT – FOLLOWED PRINCIPLES • Intraoperative intences: • - Removal/ennucleation of cysts 18th IASGO Congress - Istanbul, October 8-11, 2008

  12. TREATMENT – FOLLOWED PRINCIPLES • Intraoperative intences: • Total/partial pericystectomy 18th IASGO Congress - Istanbul, October 8-11, 2008

  13. TREATMENT – FOLLOWED PRINCIPLES • Intraoperative intences: • - Careful treatment of the cavity- closure of eroded bile channels • Check main bile channel for daughter cysts (selectively) • Pre/post operative ERCP/removal of daughter cysts (rarely) 18th IASGO Congress - Istanbul, October 8-11, 2008

  14. TREATMENT – FOLLOWED PRINCIPLES • Intraoperative intences: • Omentoplication, T-tube (selectively) • Drainage; Cavity and sub hepatic 18th IASGO Congress - Istanbul, October 8-11, 2008

  15. RESULTS 18th IASGO Congress - Istanbul, October 8-11, 2008

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  19. SURGICAL PROCEDURES • Mean postoperative hospital days: • 25.3 (min. 5, max. 93) • Gr. I: 16.6 (min. 5, max. 71) • Gr. II: 34 (min. 9, max. 93) • Bile duct exploration: • 95 pts (17.43%) • Gr. I: 43 pts (14.6%) • Gr. II: 52 pts (20.6%) CYST LOCALISATION IN THE LIVER 18th IASGO Congress - Istanbul, October 8-11, 2008

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  21. CONCLUSION • This study showed that: • Enucleation of endocysts, clean up of detritus and other materials from cavity, partial pericystectomy, closure of eroded bile channels, introflexion of pericystic edges and omentolplasty, was most often applied. • Marsupialization, endocystectomy with capitonnage as well as external drainage that were used in the past decades, had a higher postoperative complication rate and longer hospital stay compared to the previous procedure. 18th IASGO Congress - Istanbul, October 8-11, 2008

  22. Radical surgical approach to a benign pathology such as LH is not an appropriate treatment modality for hospitals with limited resources. Therefore: For large and complicated LH we recommend endocystectomy, partial pericistectomy with omentoplasty. 18th IASGO Congress - Istanbul, October 8-11, 2008

  23. THANK YOU! 18th IASGO Congress - Istanbul, October 8-11, 2008

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