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Page 4 of 9 Mansy et al. Mini-invasive Surg 2018;2:36 I http://dx.doi.org/10.20517/2574-1225.2018.48

RESULTS
Our study included 103 patients with hydatid disease. 32 (31.068%) were males and 71 were (68.932%)
females. The median age at presentation was 35 (range 10-65) years. 65 (63.11%) patients presented with
symptoms. The most common symptom was abdominal pain presented in all symptomatic patients.
Serology test was positive in 76 (73.79%) patients. Ultrasound was positive in all patients.

Cyst was solitary in 74 (71.84%) cases. The most common size of the cyst was 7-10 cm presented in 62 (60.19%)
patients. Huge cyst more than 20 cm was found in 4 patients. Most of the cysts were in the right lobe 69 (66.99%)
cases. A total of 76 (73.79%) patients had deep cysts [Table 1].

We faced complicated cysts in 30 patients, as well as ruptured cysts in 3 patients (25 years male patient with
ruptured cyst inside the CBD, 17 years male patient with ruptured central hydatid cyst discovered incidentally
during operation, which was at the area of the porta-hepatis and 35 years female patient with ruptured cyst
at segment IV discovered incidentally during operation). Infected cysts were found in 12 patients (7 of them
were due to percutaneous ultrasound (US) guided diagnostic aspiration fine needle aspiration cytopathology).

We also managed recurrent cysts in 15 cases (4 M & 11 F); 7 cases with past history of US guided drainage
and 8 cases with past history of conservative surgery (endocystectomy). Two patients after US guided
aspiration had more than 1 cyst; 1 male patient had 3 cysts (1 huge in the peritoneum, 1 in the liver and 1 in
the spleen) and 1 female with 2 cysts in the left lobe. Two females also after endocystectomy had more than
1 cyst; 1 with 3 cysts (2 of them were biliary cyst) and the other one had 2 cysts 1 in the left lobe and 1 in the
right lobe [Table 2].

Total pericystectomy was carried out on 80 (77.67%) patients [open method in 49 (47.57%) patients and
closed method in 31 (30.1%) patients]. Hepatic resection was carried out on 14 (13.59%) patients and 3 (4.3%)
patients required a subtotal pericystectomy with omentoplasty (where the IVC and hepatic veins forming
the posterior wall of the cyst).

Laparoscopic management used in 6 (5.82%) patients (laparoscopic total pericystectomy in 5 cases and
laparoscopic subtotal pericystectomy and omentoplasty in one patient).

Intra-operative US was done in 4 patients in whom the cyst was totally intra-parenchymal and not
palpable. Intra-operative cholangiography done in 9 patients. While intra-operative ERCP and stenting was
done in one female patient, that had huge cyst including CBD. Cysto-biliary communications were found
in 78 (82.6%) patients. Major communications were found in 42 (40.78%) patients. However minor cysto-
biliary communications were presented in 36 (34.95%) patients.

The mean operative time was 170 min. The average intra-operative blood loss was less than 600 mL. Thirty-two
patients needed packed RBCs transfusion while 39 patients needed FFP transfusion. The mean hospital
stay was 7 days in all patients. The mean ICU stay was 2 days in 18 (17.48%) patients.

Twenty-one (20.39%) patients developed post-operative complications with no mortality or recurrence.
Postoperative bleeding occurred in female patient after 10 h post operatively which re-explored (bleeding
was from liver bed and slipped ligature from one of the varices at the splenic bed).

Four patients developed post-operative bile leaks (one of them with right hepatectomy, biloma was at the
cut-surface that needed percutaneous US guided pigtail catheter drainage, removed after 2 weeks. The
other 3 were managed conservatively).