Laparoscopic management of hydatid cysts of the liver at a tertiary care hospital

Objective: To evaluate the feasibility and safety of laparoscopy in the management of hydatid cysts. Methodology: All consecutive patients diagnosed with liver hydatid disease were offered laparoscopic management. We performed select conservative procedures using standard laparoscopic instruments after sterilization of the cysts with 20% hypertonic saline. Deroofing, evacuation and partial cystectomy were performed. Omentoplasty was performed, and a drain was placed in the cyst cavity. Results: A total of 63 patients (M:F=48:15) with 75 cysts were managed successfully by laparoscopy. The mean age +/- SD of the patients was 38.59 +/- 11.46 years old. The mean operative time +/- SD was 88.24 +/- 23.52 minutes (range: 52-145 minutes). The mean size of the cysts was 9.2 cm (range: 5.8-16.5cm). The mean hospital stay +/- SD was 3.49 +/- 1.16 days (range: 1-7 days). There was no disease or procedure related mortality. Recurrence of a cyst was observed in 3 (4.76%) cases. Open surgery had to be performed on four patients. There were no major complications; minor biliary leaks were observed in 7 cases and cavity infections in 5 cases. The mean follow-up +/- SD in 51 patients was recorded as 28.9 +/- 31 months. Conclusion: Laparoscopic treatment of hydatid cysts of the liver is safe and effective, with low morbidity and a low recurrence rate in uncomplicated cysts. Despite some of its limitations, the procedure is a good alternative to open surgery in select cases.