Year 2014 Vol. 22 No 5

EXCHANGE OF EXPERIENCE

S.S. AMONOV1, M.I. PRUDKOV 2, M.A. KACADZE 1, O.G.ORLOV 3

MINIMALLY INVASIVE INTRAOPERATIVE DIAGNOSIS AND TREATMENT OF INTERNAL BILIARY FISTULAS IN PATIENTS WITH HEPATIC ECHINOCOCCOSIS

Republican Scientific Center of Cardiovascular Surgery 1, Dushanbe,
The Republic of Tadzhikistan,
SBEE HPE Ural State Medical University, 2
SME Sverdlovsk Regional Clinical Hospital 1, Yekaterinburg 3,
The Russian Federation

Objectives. To study the possibilities of minimal access surgery, including echinococcectomy and treatment of parasitic cavity with perhydrol for intraoperative diagnostics and treatment of the internal biliary fistulas.
Methods. During the period of 2002-2011 36 patients with liver echinococcosis aggravated by the bile ducts lesions have been operated on. In 21 (58,3%) patients hydatid cysts were located in the right lobe of the liver, in 15 (41,7%) in the left lobe. While analyzing the results, accessibility and quickness of performance as well as safety, quality changes of the fibrous capsule internal surface coloration, rate of postoperative complications have been evaluated. After patients discharge from the in-patient department, they were subject to the US liver in terms of 6-12-36-48 months.
Results. The presence of the biliary fistula could be predicted preoperatively in 7 (19,4%) patients. These patients were subjected to laparotomy, echinococcectomy with the fibrous capsule excision, closure of the biliary fistula, cholecystectomy, drainage of choledochotomy of the residual cavity and common bile duct. The presence of the biliary fistula was intraoperatively diagnosed in 4 (11,1%) patients after the fibrous capsule dissection of the hydatid cysts before treatment of the residual cavity with the perhydrol solution. The presence of the biliary fistula has not been revealed preoperatively in 25 (69,5%) patients according to US and CT data as well as laboratory tests before the surgery the presence of biliary fistula failed to detect. The presence of the internal fistula was detected only intraoperatively after treating the fibrous capsule with the perhydrol solution.
Postoperative complications were registered in 3 (8,3%) patients: bile leakage up to 80 ml per day in 1 (2,8%), pleural effusion in 1 (2,8%), postoperative wound abscess in 1 (2,8%) patient. All complications were eliminated conservatively. In long-term period the diseases relapse wasnt revealed in any case.
Conclusions. The designed method of the fibrous capsule destruction of the hydatid cyst with perhydrol can be used to treat the residual cavity of hydatid cysts and for intraoperative diagnosis of the biliary fistula during echinococcectomy.

Keywords: hydatid cyst of the liver, biliary fistula, minimal access, minimally invasive echinococcectomy, destruction of the fibrous capsule with perhydrol
p. 615-620 of the original issue
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Address for correspondence:
734003, Respublika Tadzhikistan,
g. Dushanbe, ul. Sanoi d. 33,
Respublikanskiy nauchnyiy tsentr
serdechno sosudistoy khirurgii,
endohirurgicheskot otdelenie
tel. mob.: 992-918-76-10-13,
e-mail: shuhrat.amonov@yandex.ru,
Amonov Shuhrat Shodievich
Information about the authors:
Amonov S.S. PhD, a surgeon of the endosurgical department of the Republican Scientific Center of Cardiovascular Surgery, Dushanbe.
Prudkov M.I. MD, professor, a head of the surgical diseases chair of the faculty of the advanced training and retraining of SBEE HPE Ural State Medical University, Yekaterinburg.
Kacadze M.A. MD of medical sciences, professor of the Republican Scientific Center of Cardiovascular Surgery, Dushanbe.
Orlov O.G. A surgeon of the 1st surgical department of SME Sverdlovsk Regional Clinical Hospital 1, Yekaterinburg.
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