RESUMO
BACKGROUND AND OBJECTIVES: Laparoscopic treatment of hydatid disease of the liver produces encouraging results, though its feasibility and safety have been questioned. We evaluated the feasibility and safety of laparoscopic management of hydatid disease of the liver. METHODS: Consecutive patients with this disease reporting to our department from August 1998 to January 2002 were offered laparoscopic management. Our protocol included preoperative albendazole for 4 weeks, laparoscopic cyst evacuation after its sterilization, and deroofing and suction drainage of the cavity, addition of omentoplasty if required, and a follow-up exceeding 6 months. RESULTS: Eighteen patients (M11:F7) with 22 liver hydatid cysts underwent laparoscopic surgery. The mean cyst size was 7.4 cm (range, 5.6 cm to 16.6 cm). Two patients needed conversion to an open operation. Spillage of cyst contents occurred in 5 patients. True recurrence of hydatid disease occurred in the original site in 2 patients (11%), and false recurrence was seen in 2 patients (11%), all within 6 months. CONCLUSION: With proper patient selection, laparoscopic management of hydatid cysts of the liver is a feasible option with low rates of conversion. Both true and false recurrences are common with conservative laparoscopic options, and undetected ectocysts may be the cause of true cyst recurrence.
Assuntos
Equinococose Hepática/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias , Albendazol/uso terapêutico , Anticestoides/uso terapêutico , Drenagem/métodos , Equinococose Hepática/tratamento farmacológico , Estudos de Viabilidade , Feminino , Humanos , Masculino , Recidiva , Resultado do TratamentoRESUMO
Lower gastrointestinal bleeding from submucosal lipomas of the intestine is very rare. We report our experience with 3-patients presenting with lower gastrointestinal haemorrhage who were detected to have no cause other than intestinal lipomas. In two of these patients, the lipoma was in the small intestine and presented with chronic blood loss or recurrent episodes of bleeding. The third patient presented with massive haematochyzia and had a number of lipomas in the cecum and right colon. The diagnosis was established by laparotomy and intraoperative enteroscopy in 2 cases, and by colonoscopy and laparotomy in the third. Surgical excision of the lipoma led to cure in all the patients. We conclude that when laparotomy and intraoperative enteroscopy fail to show any cause for bleeding other than an innocuous-looking lipoma, it should be excised. The literature has been reviewed.