Evaluation and comparison of the outcomes of open and laparoscopic surgery of liver hydatid cyst

Background: Hydatid disease is the parasitic infestation which is endemic in many sheep and cattle raising area of India. Previously open surgical treatment with albendazole remains the mainstay for treatment. But in the recent era of minimal invasive surgery and its advantages give privilege to laparoscopic surgery to become one of better option for the treatment of the liver hydatid disease. Objectives: The purpose of this study was to compare the difference of incidence of post-operative complications, operative duration, length of hospital stay, duration of return to work, and recurrence in patients undergoing laparoscopic or open surgery for the liver hydatid disease. Materials and methods: The present study was a multicenter study which had been carried out at the tertiary care centre. Total numbers of 36 cases were studied and were followed up for the period of 6 months to 30 months (mean 15 months). All the patients were operated either by laparoscopy or open surgery by the same surgical team depending on below mentioned criteria. Inclusion criteria for laparoscopy surgery were cyst in the segments 1, 2, 3, 4, 5, 6 of liver, cyst over the anterior surface of liver, cyst more than 6 cm. Inclusion criteria for open surgery were cyst in communication with the biliary tree, intra parenchymal and posterior cyst, cyst in the segment 7, 8 of liver, cyst lying in relation to the vital structure, infected cyst, cyst with thick or calcified wall. Results: Out of total 36 patients, 20 (55.55%) were male and the 16 (44.45%) were females. The predominant chief complain of presentation was abdominal pain in 14 (38.89%) patients followed by abdominal lump in the 13 (36.11%) patients followed by other complains. The right lobe of the liver was involved in the 20 (55.55%) patients, left lobe in 14 (38.89%) patients and both lobes involved in the 2 (5.56%) patients. The single cyst were seen in 33 (91.66%) patients and the more than one in 3 (8.34%) patients. 16 patient underwent laparoscopic surgery while 20 patient underwent open surgery. The mean operating time for the laparoscopy group was 110.0 min compare to 137.5 min for the open group ( p value <0.0001 ,which was statistically significant). The post-operative analgesic requirement was much less in the laparoscopy group (mean 2.37 days) than in the open group (mean 6.85 days; p value <0.0001, which is statistically significant). The drain was removed in the laparoscopy on an average of 4.56 days compared to the average 4.75 days for the open group; (p value = 0.36, which was >0.05; was statistically insignificant). The mean hospital stay in the laparoscopy group was 5.87 days compared to 10.85 days in the open group (p value <0.0001, which was statistically significant). Patients in the laparoscopy group resumed routine activities earlier (11.56 days) than those in the open group (27.8 days; p value=0.0006, which was statistically significant). We found no statistical significant difference in post-operative complications in the two groups except perhaps slightly higher rate in the open group than the laparoscopy group. Conclusion: Laparoscopy management of liver hydatid cyst is feasible, safe and effective provided that surgeon has good knowledge of basic laparoscopic surgery and proper selection of the patient is done.