Method for prevention forming the residual cavity in liver echinococcosis

The OBJECTIVE was to evaluate the results of the developed measures for the prevention of the residual cavity in liver echinococcectomy.

METODS AND MATERIALS. The patients were operated on in the surgical departments of the City Clinical Hospital ¹ 1 in Bishkek in 2017–2018. The article presents the results of observation of 95 patients operated on for liver echinococcosis without complications of biliary fistulas. The developed measures for the prevention of complications were used in the work. There were 2 groups (control and main). In the control group (63 people), organ-preserving operations were performed using traditional methods to eliminate the cavity of the fibrous capsule. In the main group (32 people), the same elimination methods were performed, but supplemented with the use of a hemostatic collagen sponge to prevent the occurrence of a residual cavity, and they also affected the area of the surgical wound with infrared irradiation to prevent inflammatory complications.

RESULTS. In the control group, when performing capitonage and invagination, the residual cavity was detected in 5 patients, of which 3 developed suppuration. During pericystectomy, residual cavity and bile leakage occurred in 1 case, reactive pleurisy – in 4 cases. In the control group, the residual cavity required puncture, and in 3 patients, a second operation was performed – open drainage of the festering cavity. Thus, the occurrence of residual cavity was 9.5 %, other complications – 7.9 %. In the main group, with the use of preventive measures of capitonage and invagination, the residual cavity was detected in 2 (6.3 %) cases of small size, without the presence of exudative-inflammatory phenomena, and during pericystectomy, the occurrence of a cavity and wound complications were not detected.

CONCLUSION. The application of the developed measures to prevent the occurrence of a residual cavity and inflammatory complications with the use of a hemostatic collagen sponge during capitonage and invagination made it possible to reduce the number of complications by 1.5 times. There were no complications associated with pericystectomy.

1. Kern P., Menezes da Silva A., Akhan O., Müllhaupt B., Vizcaychipi K. A., Budke C., Vuitton D. A. The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease // Adv Parasitol. 2017;(96):259– 369. Doi: 10.1016/bs.apar.2016.09.006.

2. Shevchenko Yu. L., Nazyrov F. G. Surgery of echinococcosis. Moscow, Dynasty, 2016:288. (In Russ.).

3. Paternoster G., Boo G., Wang C., Minbaeva G., Usubalieva J. M., Raimkulov K. M., Zhoroev A., Abdykerimov K. K., Kronenberg Ph. A., Müllhaupt B., Furrer R., Deplazes P., Torgerson P. R. Epidemic cystic and alveolar echinococcosis in Kyrgyzstan: an analysis of national surveillance data // The Lancet Global Health. 2020;8(4):603–611. Doi: 10.1016/S2214-109X(20)30038-3.

4. Toigombaeva V. S., Raimkulov K. M., Kuttubaev O. T. Detection and evaluation of ecchinococcosis invasion in the population of the Naryn, Osh and Batken regions of the Kyrgyz Republic // Medical parasitology and parasitic diseases. 2019;(3):25–33. (In Russ.). Doi: 10.33092/00258326mp2019.3.25-33.

5. Musaev A. I., Madaminov E. M., Aytnazarov M. S. Abdominisation of fibrous capsule cavity in the treatment of liver echinococcosis // Kazan medical journal. 2016;97(3):327–331. (In Russ.). Doi: 10.17750/KMJ2016-327.

6. Kaliyeva D. K. Echinococcosis. Actual questions of surgical treatment // Science and Health. 2014;(6):4–8. (In Russ.).

7. Stojković M., Weber T. F., Junghanss T. Clinical management of cystic echinococcosis: state of the art and perspectives // Curr Opin Infect Dis. 2018;31(5):383–392. Doi: 10.1097/QCO.0000000000000485.

8. Nazligul Y., Kucukazman M., Akbulut S. Role of chemotherapeutic agents in the management of cystic echinococcosis // Int Surg. 2015;100(1):112– 114. Doi: 10.9738/INTSURG-D-14-00068.

9. McManus D. P., Gray D. J., Zhang W., Yang Y. Diagnosis, treatment, and management of echinococcosis // BMJ. 2012;(344):E3866. Doi: 10.1136/bmj.e3866.

10. Aydin U., Yazici P., Onen Z., Ozsoy M., Zeytunlu M., Kiliç M., Coker A. The optimal treatment of hydatid cyst of the liver: radical surgery with a significant reduced risk of recurrence // Turk J Gastroenterol. 2008;19(1):33–39. PMID: 18386238.

11. Sozuer E., Akyuz M., Akbulut S. Open surgery for hepatic hydatid disease // Int Surg. 2014;99(6):764–769. Doi: 10.9738/INTSURG-D-14-00069.1.

12. Gupta N., Javed A., Puri S., Jain S., Singh S., Agarwal A. K. Hepatic hydatid: PAIR, drain or resect? // J Gastrointest Surg. 2011;15(10):1829– 1836. Doi: 10.1007/s11605-011-1649-9.

13. Mukantayev T. E. Laparjscopic tndocystectomy in patients with liver echinococcosis // Kazan medical journal. 2015;96(2):138–143. (In Russ.). Doi: 10.17750/KMJ2015-138.

14. Azizzoda Z. A., Kurbonov K. M., Rizoev V. S. Minimally invasive surgery for the liver echinococcosis // Avicenna Bulletin. 2019;21(1):116–120. (In Russ.). Doi: 10.25005/2074-0581-2019-21-1-116-120.

15. Vishnevsky V. A., Efanov M. G., Ikramov R. Z., Nazarenko N. A., Zhao A. V. Echinococcosis of the liver. Surgical treatment // Russ. J of Evidence-based gastroenterology. 2013;(2):18–25. (In Russ.).

16. Syllaios A., Schizas D., Koutras A., Zotos P. A., Davakis S., Vailas M., Hasemaki N., Triantafyllou E., Georgiou C. Abdominal pain caused by a giant liver hydatid cyst and the management of the residual cavity in a tertiary public hospital in Greece // Pan Afr Med J. 2019;(34):11. Doi: 10.11604/pamj.2019.34.11.17198.

17. Abdelraouf A., Boraii S., Elgohary H., Mogahed M., Elkholy A., Hamdy H., Hassan A. M., Hassany M., Abdellatif W. Evaluation of packing the residual cavity after total or partial cyst resection in management of hepatic hydatid cystic disease // J Egypt Soc Parasitol. 2016;46(2):453–460. PMID: 30152955.

18. Fischer L., Seiler C. M., Broelsch C. E., de Hemptinne B., Klempnauer J., Mischinger H. J., Gassel H. J., Rokkjaer M., Schauer R., Larsen P. N., Tetens V., Büchler M. W. Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: an open, randomized, prospective, multicenter, parallel-group trial // Surgery. 2011;149(1):48– 55. Doi: 10.1016/j.surg.2010.02.008.

19. Amonov Sh. Sh., Prudkov M. I., Orlov O. G., Gulmuradov T. G., Amonov Sh. N., Saidov M. S. Experience of using the wound coating «Tachocomb» in liver echinococcosis // Journal Reports of the Academy of Sciences of the Republic of Tajikistan. 2013;56(5):415–419.