Application of hepatic lobe hyperplasia techniques in the treatment of advanced hepatic alveolar echinococcosis: a single-centre experience.

BACKGROUND: This study was designed to investigate clinical efficiency and application indications of hepatic lobe hyperplasia techniques for advanced hepatic alveolar echinococcosis (AE) patients. METHODS: A retrospective case series covering 19 advanced hepatic AE patients admitted to the First Affiliated Hospital of Xinjiang Medical University from September 2014 to December 2021 and undergoing hepatic lobe hyperplasia techniques due to insufficient remnant liver volume were analyzed. Changes of liver function, lesions volume, remnant liver volume, total liver volume before and after operation have been observed. RESULTS: Among the patients, 15 underwent portal vein embolization (PVE). There was no statistical difference in total liver volume and lesions volume before and after PVE (P > 0.05). However, the remnant liver volume was significantly increased after PVE (P < 0.05). The median monthly increase rate in future liver remnant volume (FLRV) after PVE stood at 4.49% (IQR 3.55-7.06). Among the four patients undergoing two-stage hepatectomy (TSH), FLRV was larger than that before the first stage surgery, and the median monthly increase rate in FLRV after it stood at 3.34% (IQR 2.17-4.61). Despite no statistical difference in total bilirubin (TBil), albumin (Alb), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) in all patients with PVE, four patients who underwent TSH showed a decrease in ALT, AST and GGT. During the waiting process before the second stage operation, no serious complications occurred in all patients. CONCLUSIONS: For patients suffering from advanced hepatic AE with insufficient FLRV, PVE and TSH are safe and feasible in promoting hepatic lobe hyperplasia.

Long-term postoperative outcomes of Roux-en-Y cholangiojejunostomy in patients with benign biliary stricture.

BACKGROUND: Although there are common postoperative complications, Roux-en-Y cholangiojejunostomy is still broadly used as a standard surgical procedure for patients with biliary stricture. This study aimed to explore long-term risk factors of cholangiojejunostomy in patients with biliary stricture who underwent revisional cholangiojejunostomy. METHODS: Clinical data of 61 patients with biliary stricture undergoing revisional cholangiojejunostomy were retrospectively analyzed. These patients were classified into two groups (patients with traumatic biliary stricture and non-traumatic biliary stricture). Postoperative complications and survival time were successfully followed up. RESULTS: Among the patients, 34 underwent revisional cholangiojejunostomy due to traumatic biliary stricture, and 27 underwent revisional cholangiojejunostomy due to non-traumatic biliary surgery. Although there was no statistical difference in most clinical data between two groups, biliary dilation or not during the first surgery, cholelithiasis or not during the first surgery, long-term complications after first surgery, cholelithiasis or not during the second surgery, identifying abnormalities during the second surgery and long-term complications after second surgery were significantly different. All patients were successfully followed up and average follow-up time for patients with traumatic and non-traumatic biliary stricture was (88.44 ± 35.67) months and (69.48 ± 36.61) months respectively. Survival analysis indicated that there was no statistical difference in overall survival between two groups. Additionally, cox proportional hazard analysis demonstrated that first preoperative bilirubin level, short-term complication after first surgery and identifying abnormalities during the second surgery were independent risk factors that may have significant effects on patients' overall survival and long-term prognosis after cholangiojejunostomy. Among the intraoperative abnormal findings, residual lesions after the first operation had significant effects on the patients overall survival in the earlier stage. Relatively, anastomotic stoma stricture and biliary output loop problems had obvious effects on patients' overall survival at later stages. CONCLUSION: First preoperative bilirubin level, short-term complication after first surgery and abnormal findings during the second surgery were independent risk factors of revisional cholangiojejunostomy, which may affect patients' long-term survival. Therefore, surgeons should minimize incidence of postoperative complications through fully evaluating optimal operative time and standardizing surgical procedures.

Double versus single T-tube drainage for frank cysto-biliary communication in patients with hepatic cystic echinococcosis: a retrospective cohort study with median 11 years follow-up.

BACKGROUND: Partial peri-cystectomy (PPC) is one of the major surgical approaches for hepatic cystic echinococcosis (CE) and has been practiced in most centers worldwide. Cysto-biliary communication (fistula, leakage, rupture) is a problematic issue in CE patients. T-tube is a useful technique in situations where an exploration and decompression are needed for common bile duct (CBD). However, postoperative biliary complications for cystic cavity still remains to be studied in depth. METHODS: A retrospective cohort analysis of CE cases in our single center database from 2007 March to 2012 December was performed. Patients (n = 51) were divided into two cohorts: double T-tube drainage (one at CBD for decompression and one at the fistula for sustaining in cystic cavity, n = 23) group and single T-tube drainage cohort (only one at CBD for decompression, n = 28). Short-/long-term postoperative complications focusing on biliary system was recorded in detail and they were followed-up for median 11 years. RESULTS: Overall biliary complication rates for double and single T-tube drainages were 17.4% vs. 39.3% (P > 0.05). Short-term complications ranged from minor to major leakages, cavity infection and abscess formation, and prevalence was 17.4% vs. 21.4% (P > 0.05) respectively for double and single T-tube groups; most importantly, double T-tube drainage group had obvious advantages regarding long-term complications (P < 0.05), which was biliary stricture needing surgery and it was observed only in single T-tube drainage group. CONCLUSIONS: Double T-tube drainage had better outcomes without procedure-specific postoperative biliary complications than single T-tube drainage. Meanwhile, we recommend long-term follow-up when comparing residual cavity related biliary complications in CE patients as it could happen lately.

Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis.

BACKGROUND & AIMS: Radical resection is the best treatment for patients with advanced hepatic alveolar echinococcosis (AE). Liver transplantation is considered for selected advanced cases; however, a shortage of organ donors and the risk of postoperative recurrence are major challenges. The aim of this study was to assess the clinical outcomes of ex vivo liver resection and autotransplantation for end-stage AE. METHODS: In this prospective study, 69 consecutive patients with end-stage hepatic AE were treated with ex vivo resection and liver autotransplantation between January 2010 and February 2017. The feasibility, safety and long-term clinical outcome of this technique were assessed. RESULTS: Ex vivo extended hepatectomy with autotransplantation was successful in all patients without intraoperative mortality. The median weight of the graft and AE lesion were 850 (370-1,600) g and 1,650 (375-5,000) g, respectively. The median duration of the operation and anhepatic phase were 15.9 (8-24) h and 360 (104-879) min, respectively. Six patients did not need any blood transfusion. Complications higher than IIIa according to Clavien classification were observed in 10 patients. The 30-day-mortality and overall mortality (>90 days) were 7.24% (5/69) and 11.5% (8/69), respectively. The mean hospital stay was 34.5 (12-128) days. Patients were followed-up systematically for a median of 22.5 months (14-89) without recurrence. CONCLUSION: This is the largest series assessing ex vivo liver resection and autotransplantation in end-stage hepatic AE. This technique could be an effective alternative to liver transplantation in patients with end-stage hepatic AE, with the advantage that it does not require an organ nor immunosuppressive agents. LAY SUMMARY: Ex vivo liver resection and autotransplantation were performed in a large series of patients with end-stage hepatic alveolar echinococcosis. The results showed that this surgical option was feasible, with acceptable postoperative mortality, but 100% disease-free survival in survivors. Careful patient selection, as well as precise assessment for size and quality of the remnant liver are key to successful surgery.

Comparison of post-operative short-term and long-term outcomes between occult and frank biliary rupture of hydatid disease.

BACKGROUND/AIMS: Intrabiliary rupture (IBR) is the most common and serious complication of hepatic hydatid cyst (HHC). The aim of this retrospective study was to evaluate postoperative short-term and long-term outcome of patients treated surgically for complicated liver hydatid cysts. METHODOLOGY: A total of 168 cases with biliary communication of hydatid cyst were analyzed retrospectively, 92 of which had biliary communication with an occult rupture while 76 (45.23%) had Frank biliary rupture. Preoperative demography, ultrasonic cyst features, postoperative short-term complications, postoperative follow-up (long-term) complications and hospital stay were recorded and analyzed. RESULTS: There were no differences in the demographic characteristics and preoperative cyst features in Frank and occult group. Compared with the Frank group 9.34 +/- 1.25 (days), the postoperative stay in occult 6.97 +/- 1.62 (days) were relatively shorter. The incidence of overall postoperative short-term complications and long-term complications were insignificantly lower in occult group (22.82%) than Frank group (30.26%) with P = 0.275. Incidence of postoperative biliary leakage 8 (8.69%) and abscess 5 (5.43%) in occult group was insignificantly more common than Frank rupture with biliary leakage 5 (6.5%) and abscess 2 (2.63%) with P value was 0.609 and 0.365 respectively while long-term biliary stricture is significantly greater in Frank group (10.52%) then occult group (0%) with P = 0.01. CONCLUSIONS: Frequency of occurrence of postoperative short-term complications biliary fistula and abscess is relatively more common in occult rupture with transcystic drain due to its indolent course, inability to find and suture the rupture orifice, and incomplete decompression while biliary stricture is significantly more common in Frank group due to its involvement of major bile ducts.

Efficiency of Anatomical Hepatectomy in the Treatment of Hepatic Cystic Echinococcosis.

Introduction: Total cystectomy and hepatectomy are the main radical surgical procedures for hepatic cystic echinococcosis (CE). When CE lesions severely invade intrahepatic biliary ducts and vessels or single or multiple lesions occupy one hepatic lobe, performing total cystectomy is not indicated. This study aimed to analyze the clinical efficiency of anatomical hepatectomy in the treatment of patients with hepatic CE. Methods: Clinical data of 74 patients with hepatic CE who received anatomical hepatectomy were retrospectively analyzed from January 2005 to January 2022. The patients were classified into the intrahepatic biliary duct invasion group (group A), the intrahepatic vessel invasion group (group B), and the hepatic lobe occupation group (group C). Results: Among these 74 patients who received anatomical hepatectomy, right hepatectomy was performed in 20 cases (27.03%), left hepatectomy in 26 cases (35.13%), right posterior lobectomy in nine cases (12.16%), and left lateral sectionectomy in 19 cases (25.68%). Short-term post-operative complications occurred in seven cases (9.50%), including abdominal abscess in one case, pleural effusion in three cases, intestinal obstruction in one case, incision infection in one case, and ascites in one case. Long-term post-operative complications occurred in four cases (5.4%), including recurrences of CE in two cases and incisional hernias in another two cases. There were no statistical differences in the concentrations of total bilirubin, alanine aminotransferase, and aspartic transaminase before and after surgery between groups (p > 0.05). However, differences in operative time, short-term post-operative complications, average hospital stay, and number of open hepatectomy cases were statistically significant between groups (p < 0.05). The differences in cases receiving hepatic portal occlusion, intra-operative blood loss, and intra-operative blood transfusion were not statistically significant between groups (p > 0.05). Conclusions: Anatomical hepatectomy is an effective and feasible surgical procedure for patients with hepatic CE with severe invasion of intrahepatic biliary ducts and vessels or patients with huge lesions occupying one hepatic lobe, which effectively avoids residual cavity-related complications.

Primary pelvic Echinococcus granulosus infection: A case report.

BACKGROUND: Primary pelvic Echinococcus granulosus infection is clinically rare. The reported cases of pelvic Echinococcus granulosus infection are considered to be secondary to cystic echinococcosis in other organs. Single Echinococcus granulosus infection is very rare. CASE SUMMARY: In this report, we presented a case of primary pelvic Echinococcus granulosus infection admitted to the First Affiliated Hospital of Xinjiang Medical University. We described the key diagnostic points and surgical treatment of this case. We also summarized the epidemiological characteristics and pathogenesis of the disease. CONCLUSION: Our case may provide clinical data for the diagnosis and treatment of primary pelvic Echinococcus granulosus infection.

Laparoscopic treatment of pyogenic liver abscess caused by fishbone puncture through the stomach wall and into the liver: A case report.

BACKGROUND: Pyogenic liver abscess (PLA) due to foreign body penetration of the gastrointestinal tract is rare but can lead to serious consequences if not diagnosed and managed properly. We report a case of PLA caused by a fishbone puncture. CASE SUMMARY: This report describes the clinical features, diagnosis and treatment of a 56-year-old male patient who presented with severe pneumonia, acute respiratory failure and septic shock. The main clinical manifestation was a nonspecific recurrent infection. Based on the findings of abdominal computed tomography examination and the detailed medical history, the diagnosis was made as PLA which was caused by fishbone puncture through the stomach wall and into the liver. After active anti-inflammatory treatment, the patient's general condition had improved. The laparoscopic drainage of the liver abscess and the foreign body removal was performed. There was no recurrence of abscess at discharge or during follow-up and the patient's general condition was satisfactory. CONCLUSION: PLA caused by foreign bodies usually requires surgical treatment or percutaneous drainage combined with antibiotics. Our case confirms that a laparoscopic approach is safe and feasible for such cases.

Laparoscopic hepatectomy for the treatment of hepatic alveolar echinococcosis.

BACKGROUND: At present, laparoscopy is relatively mature as a minimally invasive technique, but there are few reports on this approach for the radical treatment of hepatic alveolar echinococcosis (AE). In this study, we aimed to evaluate the safety and feasibility of laparoscopic hepatectomy (LH) for AE treatment. RESULTS: A retrospective review of medical records obtained from 13 patients diagnosed with AE between January 2018 and December 2019 and treated with laparoscopic hepatectomy was conducted at the First Affiliated Hospital of Xinjiang Medical University. All patients (n = 13) underwent hepatic resection using laparoscopy and none were transferred to open surgery. The average duration of surgery was 285 min (145-580 min). Intraoperative bleeding was 305 mL (20-2000 mL). The mean duration of postoperative catheterization was 6.9 days (3-21 days), and postoperative hospital stay was 7.2 days (4-14 days). No complication of Clavien-Dindo grade III or above occurred, except for the second patient with acute liver failure post-surgically. No recurrences or deaths were observed at 9-30 months of follow-up. CONCLUSIONS: Laparoscopic hepatectomy appears to be safe and effective in selected AE patients. The advantages of this technique for AE treatment need to be further compared with the classical open approach.

TITLE: Hépatectomie laparoscopique pour le traitement de l'échinococcose alvéolaire hépatique. ABSTRACT: Contexte : À l'heure actuelle, la laparoscopie est relativement mature en tant que technique minimalement invasive, mais il existe peu de rapports sur cette approche pour le traitement radical de l'échinococcose alvéolaire hépatique (EA). Dans cette étude, nous avons cherché à évaluer la sécurité et la faisabilité de l'hépatectomie laparoscopique pour le traitement des EA. Résultats : Une revue rétrospective des dossiers médicaux obtenus auprès de 13 patients diagnostiqués pour EA entre janvier 2018 et décembre 2019 et traités par hépatectomie laparoscopique a été menée dans le premier hôpital affilié de l'Université médicale du Xinjiang. Tous les patients (n = 13) ont subi une résection hépatique par laparoscopie et aucun n'a été transféré en chirurgie ouverte. La durée moyenne de la chirurgie était de 285 min (145 à 580 min). Le saignement peropératoire était de 305 ml (20 à 2 000 ml). La durée moyenne du cathétérisme postopératoire était de 6,9 jours (3 à 21 jours) et l'hospitalisation postopératoire était de 7,2 jours (4 à 14 jours). Aucune complication de grade III ou supérieur (Clavien-Dindo) n'est survenue, sauf pour le deuxième patient présentant une insuffisance hépatique aiguë après la chirurgie. Aucune récidive ou décès n'a été observé à 9-30 mois de suivi. Conclusions : L'hépatectomie laparoscopique semble sûre et efficace chez certains patients atteints d'EA. Les avantages de cette technique pour le traitement des EA doivent être mieux comparés à l'approche ouverte classique.

Diagnosis and treatment modalities of hilar biliary duct stricture in hepatic cystic echinococcosis after endocystectomy.

AIM: Hilar biliary duct stricture may occur in hepatic cystic echinococcosis (CE) patients after endocystectomy. This study aimed to explore diagnosis and treatment modalities. METHODS: Clinical data of 26 hepatic CE patients undergoing endocystectomy who developed postoperative hilar biliary duct stricture were retrospectively analyzed and were classified into three types: type A, type B, and type C. Postoperative complications and survival time were successfully followed up. RESULTS: Imaging showed biliary duct stenosis, atrophy of ipsilateral hepatic lobe, reactive hyperplasia, hepatic hilum calcification, and dilation or discontinuity of intrahepatic biliary duct. All patients received partial hepatectomy to resect residual cyst cavity and atrophic liver tissue, and anastomosis of hepatic duct with jejunum or common bile duct exploration was applied to handle hilar biliary duct stricture. Twenty-five patients were successfully followed up. Among type A patients, one patient died of organ failure, and upper gastrointestinal bleeding and liver abscess occurred in one patient. Moreover, calculus of intrahepatic duct was found in one type B and type C patient. CONCLUSION: Long-term biliary fistula, infection of residual cavity or obstructive jaundice in hepatic CE patients after endocystectomy are possible indicators of hilar bile duct stricture. Individualized and comprehensive treatment measures, especially effective treatment of residual cavity and biliary fistula, are optimal to avoid serious hilar bile duct stricture.

TITLE: Diagnostic et modalités de traitement de la sténose du canal biliaire hilaire dans l'échinococcose kystique hépatique après endocystectomie. ABSTRACT: Objectif : une sténose du canal biliaire hilaire peut survenir chez les patients atteints d'échinococcose kystique (EK) hépatique après une endocystectomie. Cette étude visait à explorer les modalités de diagnostic et de traitement. Méthodes : Les données cliniques de 26 patients atteints de EK hépatique subissant une endocystectomie et ayant subi une sténose du canal biliaire hilaire postopératoire ont été analysées rétrospectivement, et ont été classées en trois types (type A, type B, type C). Les complications postopératoires et le temps de survie ont été suivis avec succès. Résultats : L'imagerie a montré une sténose du canal biliaire, une atrophie du lobe hépatique homolatéral, une hyperplasie réactive, une calcification du hile hépatique, une dilatation ou une discontinuité du canal biliaire intrahépatique. Tous les patients ont subi une hépatectomie partielle pour réséquer la cavité kystique résiduelle et le tissu hépatique atrophique, et une anastomose du canal hépatique avec le jéjunum ou une exploration du canal cholédoque a été appliquée pour traiter la sténose du canal biliaire hilaire. Vingt-cinq patients ont été suivis avec succès. Parmi les patients de type A, un patient est décédé d'une insuffisance organique et un saignement gastro-intestinal supérieur et un abcès hépatique sont survenus chez un patient. De plus, un calcul du canal intrahépatique a été trouvé chez un patient de type B et de type C. Conclusion : Une fistule biliaire à long terme, une infection de la cavité résiduelle ou une jaunisse obstructive chez les patients atteints d'EK hépatique après endocystectomie sont des indicateurs possibles de sténose du canal biliaire hilaire. Des mesures de traitement individualisées et complètes, en particulier un traitement efficace de la cavité résiduelle et de la fistule biliaire, sont optimales pour éviter une sténose grave des voies biliaires hilaires.

Different reconstruction methods of inferior vena cava in the ex-vivo liver resection and auto-transplantation for hepatic alveolar echinococcosis / 中华器官移植杂志

Objective:To explore the application of different reconstruction methods of retrohepatic inferior vena cava (RHIVC) in the ex-vivo liver resection and auto-transplantation(ELRA)for hepatic alveolar echinococcosis (AE).Methods:The 88 patients with end-stage hepatic AE treated by ELRA from August 2010 to December 2018 were divided into 3 groups according to the different methods of RHIVC reconstruction, respectively , group A, autologous vascular repair and reconstruction group (n=50); group B, RHIVC replacement group (n=31); group C, RHIVC resection without reconstruction group (n=7), and the clinical data were analyzed and followed up.Results:The average operation time of group A, B and C was 16.32±3.20 h, 15.99±3.32 h, 16.86±4.18 h ( P>0.05), The average anhepatic phase was398.48±104.12 min, 389.41±135.25 min, 337.43±108.65 min( P>0.05), The differences were not statistically significant. The average hospital stays after surgery in the three groups were 30.64±18.54 d, 25.94±16.37 d, 51.29±29.43 d ( P<0.05), There were significant statistical differences, and the results showed that the group B was significantly less than other two groups. The incidence of IVC related complications in group A and B was 20.0% and 9.7%. Among all the subjects, RHIVC stenosis was found in 9 patients and thrombus was formed in 4 patients in postoperative. Conclusions:RHIVC reconstruction methods can be selected appropriately according to the defect degree of lumen after resection.