Our experience with partial cystectomy in liver hydatici

INTRODUCTION AND PURPOSE: Liver hydatid disease is a parasitic infection caused by the larval form of E.Granulosus, of which humans are the intermediate host. Active; dog, fox, jackal, wolf, bear etc. As a result of carnivores contracting the agent through consuming the meat and residues of herbivores, it enters the intestinal system of these animals. It is transmitted to humans as a result of contact with these predators or their feces, or through raw or uncleaned vegetables, fruits and other foodstuffs, or through drinking water. It often invades the human body through the gastrointestinal tract and then passes to the liver through the portal system to a large extent, where it causes the majority of the disease. The pathogen, which usually settles in the liver and causes disease, can also cause disease in the lung, kidney, spleen or another organ and system. In this study; We shared our clinical experience of partial cystectomy for patients treated with the same diagnosis in our clinic. MATERIALS AND METHODS: In this study, 100 patients who were taken to laparotomy and underwent partial cystectomy due to liver hydatid cyst disease in our clinic between 01 January 2014 and 31 December 2023 were examined according to age, gender, preoperative andazole use history, preoperative PAIR, preoperative cyst granulosus IgG, type of cyst, the size of the largest cyst, whether the cyst is single or multicyst, whether the cyst is single or The presence of multiple segments, history of preoperative andazole use, presence of intraoperative cystobiliary fistula and whether fistula repair was performed, postoperative drain quality and whether there was a need for additional postoperative procedures were examined retrospectively. RESULTS: In our study, 66 (66%) of the patients were female and 34 (34%) were male. The average age was 40.7 years. The most commonly observed complaints were abdominal tenderness, vomiting and nausea. 39 of our cases had a history of preoperative andazole use, and 61 of them did not use preoperative andazole. While preoperative cyst granulosus IgG was negative in 13 patients, it was positive in 38 patients, and was not tested in 49 of them. 9 patients had previously undergone PAIR procedure, 91 patients had not undergone it. In all 100 patients examined, the cysts were isolated in the liver, and there was no other organ involvement or cyst perforation. Of the 100 patients included in the study, 33 patients had a single cyst and 67 had multiple cysts. While the cyst was localized to a single segment in 30 patients, there were multisegmentary cysts in 70 patients. Average cyst diameter; While it was 9.25 cm, the radius of the smallest cyst was 2 cm and the radius of the largest was 10 cm. According to Gharbi classification, Type 1 cyst was observed in 53 (53%) patients. Type 2 was seen in 17 of them, type 3 was seen in 26, and 4 people with type 4 underwent surgery. During the surgery, it was seen that the cyst was related to the bile ducts in 43 of the cases. In 15 of the patients who were diagnosed with intraoperative cystobiliary fistula and whose cystobiliary fistula was repaired, the postoperative drain was bilious. Postoperative bilioma developed in 2 of them and their hospital stay lasted approximately 2 weeks. In 1 patient, an abscess developed in the cyst chamber after externalization and was re-inserted after the 10th postoperative day and percutaneous abscess drainage and antibiotic treatment was given. ERCP was performed and sphincterotomy was performed in 12 of 15 patients with postoperative biliary drainage. In addition to sphincterotomy, 4 of these 12 patients also had a stent placed in the main bile duct, and 8 of them only had sphincterotomy. While the major complication level was 27% in the group with fistulization to the biliary system, it was 6.6% in the unrelated group, and a significant relationship was detected (p<0.001). CONCLUSION: Since partial cystectomy does not have any disadvantages compared to other surgical techniques in terms of postoperative complications and prolongation of hospital stay, this operation can be safely performed in appropriate cases. The most common postoperative complication in partial cystectomy cases performed in our clinic was biliary fistula, and the majority of them consisted of multicystic patients with large cyst diameters. Among the patients with postoperative biliary fistula, according to the Gharbi class, the patients who developed the most fistula had type 1 hydatid cyst structure, while the second one had biliary fistula. Patients with frequent postoperative fistula had type 3 cystic structure; however, these were not statistically significant.