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Laparoscopic versus open surgical management of liver hydatid cyst: a retrospective study

Background The liver is the most frequent organ to be affected by hydatidosis. Chemotherapy, percutaneous interventions, and surgery are the treatment options. Surgery remains the mainstay of therapy. Whether open or laparoscopic surgery, should offer the lowest morbidity, mortality, and recurrence rates. Patients and methods Retrospective evaluation of 138 patients with liver hydatid cyst in the period between March 2014 and October 2020. They were divided into two groups, group A (n=102), open surgery; group B (n=36), laparoscopic surgery. Patients with recurrent cysts or with previous hepatic surgeries were excluded. Results In group A, the mean cyst size was 11.960 ± 4.002 versus 9.444 ± 3.442 cm in group B (P=0.156). The mean operative time was 49.009 ± 6.587 and 60.138 ± 9.963 min in groups A and B, respectively (P=0.0007). The mean hospital stay was 4.676 ± 1.857 days in group A versus 3.805 ± 1.037 days in group B (P=0.0001). Four (11.11%) patients were shifted from laparoscopic to open surgery. Spillage of cyst content (clear fluid) occurred in three (8.33%) patients in group B. Persistent biliary fistula was seen in three (2.94%) patients in group A and one (2.78%) patient in group B (P=0.464), all four patients in both groups needed endoscopic retrograde cholangiopancreatography with sphincterotomy for fistula closure and all resolved within 1 week. In group A, five (4.9%) patients had incisional hernia, while in group B, one (2.78%) patient had port-site hernia (P=0.038). Four (3.92%) patients in group A versus one (2.78%) patient in group B had recurrence of the liver hydatid cyst (P=0.145). Conclusion Both laparoscopic and open approaches are safe and effective. The results are similar and comparable, and many of the open-surgery cases could be done laparoscopically if patients are properly selected. Recurrent, multiorgan hydatid cysts, multiple liver cysts, huge cysts with suspected major biliary communication, deep intraparenchymal located cysts, and those present in the blind area for laparoscopy in segments 1 and 7, are better to be managed by open surgery.