Large cysts
Cysts larger than 8 cm often contain daughter blisters and are in contact with the bile ducts - with aspiration, bile is possible, then the fistulas are precisely sutured, and drainage takes longer; the cavity after a large cyst is reduced by stitching the walls from the inside and suturing a strand of the omentum, which prevents the accumulation of fluid. The laparoscopic technique for such cysts requires experience in parasitic surgery; in case of inconvenient localization (posterior segments, breakthrough into the ducts), open surgery is chosen. Albendazole according to the regimen and ultrasound control are required.
Indications
- echinococcal cysts of the liver and abdominal cavity, confirmed by ultrasound/MSCT and serology;
- cysts are growing, superficial, with a risk of rupture;
- suppuration of the cyst, compression of ducts and vessels;
- multiple echinococcosis - staged treatment.
Principles of operation
Echinococcectomy requires strict aparasiticity: the cyst is isolated with napkins with germicide, the contents are aspirated, a scolecidal solution with exposure is introduced into the cavity, then the chitinous membrane and daughter blisters are removed, the cavity is processed and eliminated (capitonnage, omentoplasty) with drainage. Laparoscopic access with convenient localization provides an increased view of the cavity (less risk of leaving daughter blisters in the pockets) and easy recovery. Before and after surgery, albendazole is prescribed to prevent relapse; observation with ultrasound and serology - 3–5 years.
Benefits of laparoscopy
Laparoscopic access is the standard of modern abdominal surgery: instead of a 10–20 cm incision, 3–4 punctures are left, the pain after surgery is much less, the patient gets up on the day of surgery and is discharged after 1–2 days, the risk of wound infection, hernias in the scar and adhesions is several times lower, and the enlargement of the camera allows you to operate more accurately. In the clinics below, operations are performed by surgeons with extensive laparoscopic experience; hospital (SKD) is included in the price according to the price list.
