Abdominal Hydatids: A Minimally Invasive Approach

BACKGROUND: The conventional surgical procedures for managing abdominal hydatids, including those of the liver, have a very high morbidity rate in terms of hospital stay and wound complications. Less invasive procedures may thus be logical alternatives. METHOD: We enrolled 58 patients in the study. Using guided ultrasound aspiration followed by instillation of 15% saline, we were able to manage 16 patients as out-patients. In the remaining 42 patients, saline instillation was combined with laparoscopic aided percutaneous evacuation combined with partial pericystectomy. Omental packing was added in four patients. A pericystic drain tube was left in every patient managed laparoscopically. RESULTS: In the aspiration group, two sittings were required in 12 patients and more than two sittings (3 x) in two patients. Laparoscopic parameters showed an average IV infusion time of 12.3 hrs, drain removal time of 3.2 days, and discharge time of 3.2 days. Short-term complications included prolonged tube drainage for six days in one patient, intracystic bile collection in two, and intracystic pus in four patients. The aspiration group did not have any complications. Conversion to open evacuation was done in one patient. Fifty-four months of follow-up has been recurrence free. CONCLUSION: Minimally invasive management, including aspiration and laparoscopic intervention, appear to be viable alternatives to open surgery because they result in less morbidity.