Tactical and Technical Features of Performing Laparoscopic Echinococcectomy from the Liver

Objective: to determine the tactical and technical features of laparoscopic echinococcectomy (LapEE) in liver echinococcosis (LE). Methods: The study included patients with the primary form of EP - 46 patients who underwent LapEE at the State Institution “RSSPMCS named after acad. V.Vakhidov". Results: Taking into account the stage of cyst development, various difficulties with aspiration or removal of the cyst contents occurred in only 14 (30.4%) cases, more often with type II-IV CE. Another problem was the difficulty with adequate revision and treatment of residual cavity (RC) (in 6 (13.0%) patients) with predominantly intraparenchymal localization. Difficulties with performing percytectomy with sufficient excision of the fibrous capsule were noted in 9 (19.6%) cases. In the period up to a week after the operation, the drainage was removed for cysts up to 8 cm in 11 (36.7%), with more than 8 cm - in 5 (31.3%). By 3 weeks of observation, the drains were removed in all cases with cysts up to 8 cm, while with large sizes in 12.5% (2 patients) cases, the drainage was removed on days 21-28 and in 1 (6.3%) patient more than late period. In general, in the group, complications from the RC on days 9-27 after LapEE were noted in 10 (21.7%) of 46 patients, fluid accumulation in 8 (17.4%) and suppuration in 2 (4.3%). Conclusion: Among the main factors that technically complicate LapEE, in addition to localization, difficulties with aspiration or removal of cyst contents in CE II, III, and IV are highlighted due to the presence of many daughter cysts that completely fill the maternal membrane (CE II, III) or thick viscous discharge (CE IV), as well as difficulties in performing a pericystectomy for adequate elimination of the RC when the hydatid is located 3/4 or more in the liver parenchyma.

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