SCOPE THE PARASITE
A Case series on Retroperitoneal hydatids managed laparoscopically
EAES Academy. Wagh A. 07/05/22; 363154; P199
A Case series on Retroperitoneal hydatids managed laparoscopically
Dr. Amol Wagh
Contributions
Contributions
Abstract
Introduction:
Retroperitoneal Hydatid cyst is exceptionally rare and only a small number of cases have been reported after Lockhart and Sapinza first reported a primary retroperitoneal Hydatid cyst. Hydatid cyst developed in retroperitoneal space without accompanied lesion in other organs is defined as primary retroperitoneal hydatid cyst. The annual incidence of cystic echinococcus is 220 per 100,000 inhabitants in the endemic areas like Mediterranean countries, Central Asia including the Tibetan Plateau, Northern and Eastern Africa, Australia, and South America.
Hematogenous dissemination is the most widely accepted hypothesis to explain the pathogenesis as the oncospheres in blood pass through the liver and lungs without seeding, and develop an implant in retro peritoneum.
With the worldwide incidence of just 1-3%, the paucity of cases and dearth in the reports of diagnosed ones makes this case a rare entity all together.
Method:
At Grant Medical College, Mumbai, A total of 8 cases were operated for laparoscopic retroperitoneal Hydatid cyst and cystectomy was done in all the cases. On Computed tomography imaging all the patients had isolated retroperitoneal Hydatid cyst with no other primary lesions in Liver or lungs. Patients were given Tab. Albendazole (10 mg/kg/day) pre-operatively for 6 weeks for reducing the total parasitic load. The Laparoscopic ports were inserted through the flanks with adequate pneumoperitoneum created and total cystectomy was done in all cases without any spillage of contents.
The dissection was done via white line of toldt and laterally the cyst was dissected out first, further planes were created through all other sides and total enmass removal of the cyst was achieved.
Results:
The mean operative time was 103.5 minutes and Average blood losses of 50 ml. Patients were discharged on POD 1 with Tab. Albendazole for 2 months post operatively (10 mg/kg/day). The mean hospital stay was 2 days. No recurrences were reported in a follow up period of 3 years.
Conclusion:
Owing to the rarity of cases reported and no specified approach defined in the literature, it becomes extremely important to highlight this novel Laparoscopic approach for excision of retroperitoneal Hydatid cyst with combined medical therapy.
The overall approach has resulted in fewer recurrences than expected and hence medical therapy should be considered as an adjuvant with Minimal access surgeries.
Retroperitoneal Hydatid cyst is exceptionally rare and only a small number of cases have been reported after Lockhart and Sapinza first reported a primary retroperitoneal Hydatid cyst. Hydatid cyst developed in retroperitoneal space without accompanied lesion in other organs is defined as primary retroperitoneal hydatid cyst. The annual incidence of cystic echinococcus is 220 per 100,000 inhabitants in the endemic areas like Mediterranean countries, Central Asia including the Tibetan Plateau, Northern and Eastern Africa, Australia, and South America.
Hematogenous dissemination is the most widely accepted hypothesis to explain the pathogenesis as the oncospheres in blood pass through the liver and lungs without seeding, and develop an implant in retro peritoneum.
With the worldwide incidence of just 1-3%, the paucity of cases and dearth in the reports of diagnosed ones makes this case a rare entity all together.
Method:
At Grant Medical College, Mumbai, A total of 8 cases were operated for laparoscopic retroperitoneal Hydatid cyst and cystectomy was done in all the cases. On Computed tomography imaging all the patients had isolated retroperitoneal Hydatid cyst with no other primary lesions in Liver or lungs. Patients were given Tab. Albendazole (10 mg/kg/day) pre-operatively for 6 weeks for reducing the total parasitic load. The Laparoscopic ports were inserted through the flanks with adequate pneumoperitoneum created and total cystectomy was done in all cases without any spillage of contents.
The dissection was done via white line of toldt and laterally the cyst was dissected out first, further planes were created through all other sides and total enmass removal of the cyst was achieved.
Results:
The mean operative time was 103.5 minutes and Average blood losses of 50 ml. Patients were discharged on POD 1 with Tab. Albendazole for 2 months post operatively (10 mg/kg/day). The mean hospital stay was 2 days. No recurrences were reported in a follow up period of 3 years.
Conclusion:
Owing to the rarity of cases reported and no specified approach defined in the literature, it becomes extremely important to highlight this novel Laparoscopic approach for excision of retroperitoneal Hydatid cyst with combined medical therapy.
The overall approach has resulted in fewer recurrences than expected and hence medical therapy should be considered as an adjuvant with Minimal access surgeries.
Introduction:
Retroperitoneal Hydatid cyst is exceptionally rare and only a small number of cases have been reported after Lockhart and Sapinza first reported a primary retroperitoneal Hydatid cyst. Hydatid cyst developed in retroperitoneal space without accompanied lesion in other organs is defined as primary retroperitoneal hydatid cyst. The annual incidence of cystic echinococcus is 220 per 100,000 inhabitants in the endemic areas like Mediterranean countries, Central Asia including the Tibetan Plateau, Northern and Eastern Africa, Australia, and South America.
Hematogenous dissemination is the most widely accepted hypothesis to explain the pathogenesis as the oncospheres in blood pass through the liver and lungs without seeding, and develop an implant in retro peritoneum.
With the worldwide incidence of just 1-3%, the paucity of cases and dearth in the reports of diagnosed ones makes this case a rare entity all together.
Method:
At Grant Medical College, Mumbai, A total of 8 cases were operated for laparoscopic retroperitoneal Hydatid cyst and cystectomy was done in all the cases. On Computed tomography imaging all the patients had isolated retroperitoneal Hydatid cyst with no other primary lesions in Liver or lungs. Patients were given Tab. Albendazole (10 mg/kg/day) pre-operatively for 6 weeks for reducing the total parasitic load. The Laparoscopic ports were inserted through the flanks with adequate pneumoperitoneum created and total cystectomy was done in all cases without any spillage of contents.
The dissection was done via white line of toldt and laterally the cyst was dissected out first, further planes were created through all other sides and total enmass removal of the cyst was achieved.
Results:
The mean operative time was 103.5 minutes and Average blood losses of 50 ml. Patients were discharged on POD 1 with Tab. Albendazole for 2 months post operatively (10 mg/kg/day). The mean hospital stay was 2 days. No recurrences were reported in a follow up period of 3 years.
Conclusion:
Owing to the rarity of cases reported and no specified approach defined in the literature, it becomes extremely important to highlight this novel Laparoscopic approach for excision of retroperitoneal Hydatid cyst with combined medical therapy.
The overall approach has resulted in fewer recurrences than expected and hence medical therapy should be considered as an adjuvant with Minimal access surgeries.
Retroperitoneal Hydatid cyst is exceptionally rare and only a small number of cases have been reported after Lockhart and Sapinza first reported a primary retroperitoneal Hydatid cyst. Hydatid cyst developed in retroperitoneal space without accompanied lesion in other organs is defined as primary retroperitoneal hydatid cyst. The annual incidence of cystic echinococcus is 220 per 100,000 inhabitants in the endemic areas like Mediterranean countries, Central Asia including the Tibetan Plateau, Northern and Eastern Africa, Australia, and South America.
Hematogenous dissemination is the most widely accepted hypothesis to explain the pathogenesis as the oncospheres in blood pass through the liver and lungs without seeding, and develop an implant in retro peritoneum.
With the worldwide incidence of just 1-3%, the paucity of cases and dearth in the reports of diagnosed ones makes this case a rare entity all together.
Method:
At Grant Medical College, Mumbai, A total of 8 cases were operated for laparoscopic retroperitoneal Hydatid cyst and cystectomy was done in all the cases. On Computed tomography imaging all the patients had isolated retroperitoneal Hydatid cyst with no other primary lesions in Liver or lungs. Patients were given Tab. Albendazole (10 mg/kg/day) pre-operatively for 6 weeks for reducing the total parasitic load. The Laparoscopic ports were inserted through the flanks with adequate pneumoperitoneum created and total cystectomy was done in all cases without any spillage of contents.
The dissection was done via white line of toldt and laterally the cyst was dissected out first, further planes were created through all other sides and total enmass removal of the cyst was achieved.
Results:
The mean operative time was 103.5 minutes and Average blood losses of 50 ml. Patients were discharged on POD 1 with Tab. Albendazole for 2 months post operatively (10 mg/kg/day). The mean hospital stay was 2 days. No recurrences were reported in a follow up period of 3 years.
Conclusion:
Owing to the rarity of cases reported and no specified approach defined in the literature, it becomes extremely important to highlight this novel Laparoscopic approach for excision of retroperitoneal Hydatid cyst with combined medical therapy.
The overall approach has resulted in fewer recurrences than expected and hence medical therapy should be considered as an adjuvant with Minimal access surgeries.
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