Surgical management of hydatid cyst disease of the liver: An improvement from our previous experience?

Table 1 Demographic data and concurrent comorbidities in the patient population

Parameter		Laparoscopic, n = 70 (%)	Open approach, n = 170 (%)	P value
Age	Mean age	39.87 ± 14.4	44.36 ± 15.99	0.03
Sex	Male	29 (41.42)	80 (47.28)	0.4
	Female	41 (58.58)	90 (52.72)
Environment	Urban	29 (41.42)	65 (38.04)	0.61
	Rural	41 (58.58)	105 (61.96)
Symptoms	Pain in the RUQ	50 (71.42)	119 (70.1)	0.83
	Biliary dispeptic syndrome	12 (17.14)	40 (23.36)	0.28
	Cutaneous eruption	0 (0)	4 (2.71)	0.16
	Hepatomegalia w/palpable mass	1 (1.42)	7 (4.3)	0.46
Comorbidities	Hypertension	9 (12.85)	32 (19.02)	0.24
	Ischemic cardiopathy	2 (2.85)	14 (8.15)	0.13
	Type II diabetes	4 (5.71)	12 (7.06)	0.78
	Obesity	6 (8.57)	20 (11.9)	0.43
ASA	1 or 2	37 (52.85)	90 (53.2)	0.36
	3	29 (41.42)	68 (40.2)	0.97
	4	4 (5.71)	12 (6.5)	0.95
Hydatid elements in the CBD		6 (8.57)	19 (11.17)	0.34
Median ALT value		45 (25-180)	42 (25-220)	0.88
Median AST value		40 (25-190)	45 (20-225)	0.76

RUQ: Right upper quadrant; CBD: Cannabidiol; ASA: American Society of Anesthesiologists; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.

Table 2 Characteristics of the cysts and intraoperative parameters

Parameter		Laparoscopic, n = 70 (%)	Open approach, n = 170 (%)	P value
Liver segments	II-IV	27 (38.5)	41 (24.11)	0.04
	V-VI	28 (40)	48 (28.23)	0.14
	VII	20 (28.57)	63 (37.05)	0.03
	VIII	15 (21.42)	54 (31.24)	0.02
	I	1 (1.42)	11 (6.47)	0.06
Distribution	Right lobe	44 (62.85)	105 (61.95)	0.89
	Left lobe	18 (25.72)	31 (18.48)	0.2
	Both lobes	8 (11.43)	34 (20)	0.14
Number of cysts	Unique cysts	59 (84.28)	134 (72.82)	0.04
	Multiple cysts	11 (15.72)	50 (27.18)
Dimension of cysts	Smaller than 5 cm	17 (24.28)	37 (20.13)	0.41
	5-10 cm	47 (67.14)	113 (61.42)	0.38
	Larger	6 (8.57)	34 (18.45)	0.06
	Median diameter (cm)	6.5 (2-17)	7.5 (2-20)	0.001
	No cystobiliary communication (cm)	5.5 (2-17)	7 (2-17)	0.02
	With cystobiliary communication (cm)	6 (4-10)	8 (3-20)	0.01
Type of cyst	Pure clear fluid cyst	16 (22.85)	39 (22.82)	0.93
	Hydatid daughter cyst	33 (47.14)	70 (41.3)	0.86
	Calcified cyst	9 (12.85)	33 (19.56)	0.43
	Avital hydatid cyst	6 (8.57)	5 (2.92)	0.07
	Secondarily infected cyst	6 (8.57)	23 (13.58)	0.22
Type of surgery	Lagrot percystectorny	56 (80)	118 (69.56)	0.26
	Total percystectomy	8 (11.45)	33 (20.1)	0.14
	Hepatic resection	6 (9.55)	19 (11.34)	0.67
Surgical parameters	Intraoperative complications	0 (0)	9 (4.89)	0.04
	Postoperative complications	4 (5.7)	13 (7.06)	0.76
	Presence of cysto-biliary fistula	13 (18.57)	56 (32.9)	0.01
	Median operative time (min)	75 (50-110)	100 (55-280)	0.001
	Median blood loss (mL)	35 (0-120)	90 (0-400)	0.001
Postoperative mortality		0 (0)	0 (0)	1

Table 3 Reasons for conversion to open surgery

Reasons for conversion to open surgery
Unable to find the cyst based on the imaging	2
Difficult access	2
Unable to suture the cystobiliary fistula	1
Unable to provide adequate haemostasis	1
Difficulty in mobilizing the liver	1
Total	7

Table 4 Postoperative complications

Complications	Laparoscopic, n = 70 (%)	Open approach, n = 170 (%)	P value
Postoperative complications	4 (5.7)	13 (7.06)	0.76
Abdominal wound complications	0 (0)	8 (4.7)	0.04
External fistulas	1 (1.4)	1 (0.58)	0.93
Liver abscesses	3 (4.28)	4 (2.35)	0.21

Table 5 Postoperative parameters

Postoperative parameter	Laparoscopic, n = 70 (%)	Open approach, n = 170 (%)	P value
Recurrence rate	3 (4.2)	9 (5.2)	0.63
Median hospital stay	4 (2-11)	6 (3-21)	0.01
Median follow-up period	24 (9-48)	26 (648)	0.35

Table 6 Comparison of the current and previous laparoscopic groups

Postoperative parameter		Cument laparoscopic group, n = 70 (%)	Previous laparoscopic group, n = 59 (%)	P value
Surgery type	Lagrot pericystectomy	56 (80)	54 (91.52)	0.11
	Total pericystectorny	8 (11.45)	5 (8.48)	0.79
	Hepatic resection	6 (9.55)	0 (0)	0.04
Postoperative morbidity		4 (5.71)	6 (10.16)	0.11
Frequency (%)		28.34	17.71	0.005
Median cyst size		6.5 (2-17)	6.4 (2-15)	0.28
Median duration (min)		75 (50-110)	72 (45-130)	0.41
Conversion rate (%)		8.10	4.80	0.17
Median hospital stay (d)		4 (2-11)	6 (1-28)	0.001