Total vascular isolation in segmental liver resection for echinococcal cyst: case report
DOI:
https://doi.org/10.18203/2349-2902.isj20250827Keywords:
Liver echinococcosis, Surgical treatment, Liver resection, Vascular isolationAbstract
Liver echinococcosis is a widespread parasitic disease that does not tend to decrease in endemic regions. High frequency of complications, reaching up to 57%, relapses of the disease, accompanied by repeated surgeries, leave the problem relevant at the present time. The main purpose of the work is to improve the results of treatment of patients with echinococcal liver cysts. This article presents, the outcomes of surgical interventions in two patients, with echinococcal liver cysts who underwent segmental liver resections of the liver, employing total vascular isolation (TVI) technique, which is carried out at the department of pancreatology hepatology and transplantation of organs and tissues, Grodno regional clinical hospital in Grodno, Belarus. Our entire team performed segmental liver resection of echinococcal cysts using the technique of TVI for the both patients who presented with symptoms of abdominal discomfort in their right upper quadrant and further imaging studies confirmed the presence of cystic lesions within the 6 and 7 liver segments, intricately intertwined with major hepatic vessels. Both the patients had optimal surgical outcomes with minimal intraoperative blood loss while preventing major complications including air embolism, with the employment of the method of TVI. The use of the method of TVI allows to significantly reduce intraoperative blood loss, and also makes it possible to avoid extensive resections in echinococcal liver cysts.
Metrics
References
Vishnevsky VA, Ikramov RZ, Kakharov MA, Efanov MG. Radical treatment of liver echinococcosis. Current state of the problem. Bull Siberian Med. 2007. DOI: https://doi.org/10.20538/1682-0363-2007-3-22-26
Czermak BV, Akhan O, Hiemetzberger R, Zelger B, Vogel W, Jaschke W, et al. Echinococcosis of the liver. Abdom Imaging. 2008;33(2):133-43. DOI: https://doi.org/10.1007/s00261-007-9331-0
Rinaldi F, Brunetti E, Neumayr A, Maestri M, Goblirsch A, Tamarozzi F. Cystic echinococcosis of the liver: A primer for hepatologists. World J Hepatol. 2014;6(5):293-305. DOI: https://doi.org/10.4254/wjh.v6.i5.293
Polyakov NV, Romikh VV, Safarov RM, Polyakov VE. Single-chamber (hydatid) echinococcosis. Res Practical Med J. 2015;2(1):27-35. DOI: https://doi.org/10.17709/2409-2231-2015-2-1-27-35
Pakala T, Molina M, Wu GY. Hepatic Echinococcal Cysts: A Review. J Clin Transl Hepatol. 2016;4(1):39-46. DOI: https://doi.org/10.14218/JCTH.2015.00036
Nunnari G, Marilia RP, Salvatore G, Benedetto MC, Giordano M, Giulia M, et al. Hepatic echinococcosis: Clinical and therapeutic aspects. World J Gastroenterol. 2012;18(13):1448-58. DOI: https://doi.org/10.3748/wjg.v18.i13.1448
Tolstokorov AS, Gergenreter YS. Treatment of echinococcosis of the diaphragmatic surface of the liver. Modern problems of science and education. 2013; 5.
Solontsova EN. Modern high-tech plasma method of liver resection with its focal lesions. Dissertation of the Candidate Of Medical Sciences. 2015;118.
Yurlevich DI, Kirkovskii LV, Korotkov SV, Fedoruk AM, Shuleiko AC, Bolonkin LS, et al. Application of selective vascular isolation in liver surgery. News Surg. 2008;4:126-30.
Bismuth H, Castaing D, Garden J. Major hepatic resection under total vascular exclusion. Ann Surg. 1989;210(1):13-9. DOI: https://doi.org/10.1097/00000658-198907000-00002
Okello M, Nuwagaba J, Nduhukire FD. Laparoscopic deroofing of recurrent giant echinococcal and simple liver cysts in Uganda: a case series. IJS Short Reports. 2022;7(1):e41. DOI: https://doi.org/10.1097/SR9.0000000000000041
Perdomo R, Alvarez C, Monti J, Ferreira C, Chiesa A, Carbó A, et al. Principles of the surgical approach in human liver cystic echinococcosis. Acta Trop. 1997;64(1-2):109-22. DOI: https://doi.org/10.1016/S0001-706X(96)00641-9
Velasco-Tirado V, Alonso-Sardón M, Lopez-Bernus A, Romero-Alegría A, Javier Burguillo F, Muro A, et al. Medical treatment of cystic echinococcosis: Systematic review and meta-analysis. BMC Infect Dis. 2018;18(1):306. DOI: https://doi.org/10.1186/s12879-018-3201-y
Velasco-Tirado V, Romero-Alegria A, Pardo-Lledías J, Alonso-Sardón M, Lopez-Bernus A, Qiñones Sampedro J, et al. Management of cystic echinococcosis in the last two decades: What have we learned? Trans R Soc Trop Med Hyg. 2018;112(5):207-15. DOI: https://doi.org/10.1093/trstmh/try050
Smego RA, Sebanego P. Treatment options for hepatic cystic echinococcosis. Int J Infect Dis. 2005;9(2):69-76. DOI: https://doi.org/10.1016/j.ijid.2004.08.001
Brunetti E, Kern P, Vuitton DA, Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010;114(1):1-16. DOI: https://doi.org/10.1016/j.actatropica.2009.11.001
Todorov T, Boeva V. Human echinococcosis in Bulgaria: a comparative epidemiological analysis. Bull World Health Organ. 1999;77(2):110-8.
Lewall DB, McCorkell SJ. Hepatic echinococcosis: sonographic, radiologic and CT features. Am J Roentgenol. 1985;144(6):1257-68.
Cherqui D, Malassagne B, Colau PI, Brunetti F, Rotman N, Fagniez PL. Hepatic vascular exclusion with preservation of the caval flow for liver resections. Ann Surg. 1999;230(1):24-30. DOI: https://doi.org/10.1097/00000658-199907000-00004
Manzanet G, Ventureyra M, Gores GJ. Transient sinusoidal obstruction after total vascular exclusion during liver resection. Arch Surg. 1997; 132(7):771-6.
Yin ZY, Xiao-Ming W, Ren-Xiang Y, Bai-Meng Z, Ke-Ke Y, Ning L, et al. Total vascular exclusion technique for resection of hepatocellular carcinoma. World J Gastroenterol. 2003;9(10):2194-7. DOI: https://doi.org/10.3748/wjg.v9.i10.2194
Tzovaras G, Baloyiannis I, Zacharoulis D. Surgical management and long term follow up of hepatic hydatid disease. HPB Surg. 2009.
Avgerinos ED, Pavlakis E, Stathoulopoulos A, Manoukas E, Skarpas G, Tsatsoulis P. Clinical presentations and surgical management of liver hydatidosis: our 20 year experience. HPB (Oxford). 2006;8(3):189-93. DOI: https://doi.org/10.1080/13651820500539495
Velasco-Tirado V, Romero-Alegría A, Belhassen-García M, Alonso-Sardón M, Esteban-Velasco C, López-Bernús A, et al. Recurrence of cystic echinococcosis in an endemic area: a retrospective study. BMC Infect Dis. 2017;17(1):455. DOI: https://doi.org/10.1186/s12879-017-2556-9