Laparoscopic partial pericystectomy of Echinococcus granulosus cysts in the liver.

Laparoscopic partial pericystectomy is a promising new therapeutical approach in surgery of hydatid liver disease. In combination with a review of the published results of laparoscopic therapy for hydatid disease the actual relevance of this technique should be defined. Together with our own experience with this technique we evaluated all patients with hydatid liver disease from Echinococcus granulosus published in literature operated either by pericystectomy or by partial pericystectomy. The review was projected as a search over DIMDI data access. This technique is practicable without increasing the risk of intraabdominal spillage of scolices if well-known security criteria are respected. Additional training is not necessary. Laparoscopic treatment of Echinococcus multilocularis is not possible yet, as complicated liver resections may be required for these patients. Hydatid hepatic cysts of E. granulosus however may be operated upon laparoscopically and do not necessarily require open surgery. While working under visual control minimal invasiveness is achievable and post-operative hospital stay can be reduced. This new technique is a feasible method, especially regarding obese patients, but on the other hand it is limited by a laparoscopically inaccessible intrahepatic localization (Segments IVa, VII, VIII and small centrally located cysts).