Correction of post-echinococcectomy residual cavities in hepatic hydatidosis in children

Abstract

Introduction: Correction of residual cavities is one of the most controversial issues in the surgery of the hepatic hydatid cyst in children. A great array of surgical technologies confirms that none of the proposed methods is “ideal” in resolving residual cavity in hepatic hydatidosis in children. The purpose of the work was to concretize morphological peculiarities in the recurrent massive hydatid cyst in children with optimization of the method of capitonage used in post-echinococcectomy correction of the residual cavities in these clinical evolutionary forms of the disease. Material and Methods: The study is based on a complex clinical and morphological analysis of 29 children aged 2-17 years treated surgically in the Department of Surgery of the National ScientificPractical Centre of Pediatric Surgery “Natalia Gheorghiu” of SRIMCHC during 2008 - 2011 with massive hepatic hydatid cyst (n=16), complicated forms (n=8) and relapsing hydatidosis (n=5). Gender distribution of parasitic lesions showed prevailing affection in boys - 21 (%) versus females - 8 cases (%). Topographic study of hydatidosis revealed a predominant distribution in the right lobe of the liver in 17 (%) cases, left - in 8 (36%) cases, a bilateral affection being recorded in 4 cases. Imaging examination results (abdominal echography, CT, liver scintigraphy) were confronted with the pathomorphological examination data, which included studies of the hydatid larval cyst and the determination of changes of the affected organ. We used plastic material “LitAr” to seal the residual cavity subjected to capitonage which is a collagenhydroxyapatite preparation.The preparation was used concurrently with the capitonage of the residual cavities, filling 2/3 of the volume of these spaces. Results: Use of this plastic material has allowed us to obtain a stable hemostasis and biliary stasis in post-echinococcectomy residual cavities in all the cases. Time necessary for adequate sealing of residual cavities was 20-25 days. This time proved to be sufficient for triggering local reparative phenomena. Adverse reactions were recorded in 3 cases which manifested by: increase of body temperature, which were subsequently ceased. Conclusions: The obtained results allow us to conclude that the method of staged capitonage “forward and back” in combination with filling of the residual cavities with plastic “Lit Ar” allow to improve the results of surgical treatment in hepatic hydatidosis in children.