Surgical Treatment of Hydatid Cyst of the Hepatic Dome via Transdiaphragmatic Approach.

Abstract

<bold>Introduction:</bold> Echinococcosis constitutes a public health problem in several countries of the Mediterranean basin. Liver damage is the most common. For certain presentations, the thoracic approach can be a simple and effective route for parasite control. <bold>Methods:</bold> Patients who were operated on for hydatic cyst of the liver dome treated by thoracotomy from January 2022 to January 2024 were identified. <bold>Results:</bold> The study involved 17 patients; consisting of 11 males and 6 females. The average age was 54 years (18to 80years). Among the participants, 8 individuals (47%) had prior history of hydatid liver cysts that were treated through laparotomy. Clinical presentations varied, with symptoms including hemoptysis, cough, fever, right hypochondrium pain, sputum containing hydatid fluid and biliptysis while 4 patients showed neither symptoms. The thoracic surgical approach was justified by factors such as recurrence of the liver cyst(47%), concomitant lung involvement(29%) or the presence of a ruptured cyst in the chest(24%). All patients were operated on via a posterolateral thoracotomy through the 7th or 8th intercostal space. The liver cyst was evacuated after a phrenotomy measuring 9cm on average. The median duration of postoperative hospitalization was 3days. The thoracic drain was removed after 2days and the abdominal drain was kept for a median duration of 3 days. 3patients developed a biliary fistula and required prolonged subphrenic drainage:6,8 and 47days. <bold>Conclusion:</bold> These results prove that the management of hydatid cysts of the liver by transphrenic approach must be considered in order to facilitate management as it allows a direct approach.the main complication is biliary fistula, requiring prolonged drainage.