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A Prospective Nonselective Study Using the Isolated Hypobaric Technique

Amitai Bickel, MD; Norman Loberant, MD; Jonathan Singer-Jordan, MD; Moshe Goldfeld, MD; George Daud, MD; Arie Eitan, MD

Arch Surg. 2001;136:789-795.

Hypothesis  The laparoscopic isolated hypobaric technique that we developed and use is safe and feasible for almost all kinds of hepatic and extrahepatic abdominal hydatid cysts.

Design  A case series.

Patients  Between August 1992 and December 1999, 31 patients with no selection criteria underwent 32 consecutive laparoscopic operations for 52 symptomatic hydatid cysts located in the liver (49), spleen (1), and pelvis (2). Eleven patients underwent surgery for between 2 to 5 cysts.

Interventions  The main surgical maneuvers (puncture, parasite neutralization, and complete evacuation) were performed through an assembled transparent cannula, in which a vacuum was created, while its tip adhered firmly to the cyst wall. Following evacuation of the cyst contents, we attempted to perform partial pericystectomy, omentoplasty, and closed-suction drainage.

Main Outcome Measures  Surgical complications and postoperative disease recurrence.

Results  Mean cyst diameter was 8.4 cm (range, 3.5-25 cm). Seven cysts were subdiaphragmatic, and 6 were on the posterior (hidden) aspect of the liver. Mean postoperative follow-up was 49 months. Forty-one cysts contained live parasites, and 11 were secondarily infected. Twenty-four cysts were complex. Perioperative complications occurred in 5 patients, including 1 patient who died 1 month after surgery owing to Candida sepsis. Mean hospital stay was 6 days. No evidence of recurrence was recorded during follow-up.

Conclusions  The isolated hypobaric laparoscopic technique described provides a safe and efficacious approach to almost all types of abdominal hydatid cysts and takes advantage of the recognized benefits of the laparoscopic approach.

From the Departments of Surgery (Drs Bickel, Daud, and Eitan) and Radiology (Drs Loberant, Singer-Jordan, and Goldfeld), Western Galilee Hospital, Nahariya, Israel, affiliated with the Rappaport School of Medicine, the Technion, Israel Institute of Technology, Haifa.

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