Minimally-invasive treatment of hepatic hydatid disease with Perforator-Grinder-Aspirator Apparatus and follow-up of 42 patients.

INTRODUCTION: The gold standard treatment for hydatid cyst (HC) is surgery. In surgical practice, open procedures still remain as the first option but in this minimally-invasive era, the frequency of laparoscopic procedures is increasing. The aim of this study is to evaluate the results of 42 patients with HC who underwent surgery with Perforator-Grinder-Aspirator-Apparatus (PGAA) and demonstrate the success and reliability of this technique. METHODS: The datas of 42 patients, who underwent laparoscopic surgery with PGAA between Jan 2010 and Feb 2016 were evaluated retrospectively. All patients diagnosed with ultrasonography and underwent computed tomography to identify the surgical anatomy, accessibility of the cyst and the relation with the other cysts. All patients had 10 mg/kg/day albendazole treatment at least 10 days before surgery and preoperative antibiotic prophylaxis was made by 1 gr ampicillin/sulbactam. RESULTS: Thirty-two patients had single cysts, 9 patients had 2 cysts and 1 patient had 3 cysts. Of the 53 cysts ; unroofing and drainage was performed to 38 cysts, unroofing-drainage and omentopexy were performed to 7 cysts and simple drainage was performed to 8 cysts. Four complications occurred after the procedure. The average duration of hospital stay was 4.73 ± 2.6 days. DISCUSSION AND CONCLUSION: There are several treatment options in hydatid cyst and the most appropriate must be selected depending on the patient. We believe that the use of PGAA can increase the use of laparoscopy in cystic hydatidosis of liver and will achieve better results.

Obstructive jaundice secondary to endoclip migration into common bile duct after laparoscopic cholecystectomy.

Obstructive jaundice is a rare condition due to foreign body in common bile. In this article we report a 69 year-old man who was diagnosed obstructive jaundice secondary to the endoscopic clip migration. The patient had been performed laparoscopic cholecystectomy 5 years ago and had recovered without any complications. He presented with abdominal pain and jaundice. The magnetic resonance cholangiopancreatography (MRCP) revealed filling defect in choledoch consistent with a bile duct stone. The endoscopic retrograde cholangiopancreatography (ERCP) exhibited an endoclip migration into the common bile duct which caused bile duct stone. Endoclips can migrate into bile duct and cause obstructive jaundice. ERCP is the first option for its treatment.

Comparison of histopathological features and prognosis of classical and follicular variant papillary thyroid carcinoma.

PURPOSE: To compare the histopathological features and the outcomes of the follicular variant and classical variant of papillary thyroid carcinoma. MATERIAL AND THE METHODS: Demographic data, histopathological features (tumor size, thyroid capsule invasion, extrathyroidal extension, vascular invasion and multicentricity), lymph node metastasis, local recurrence, distant metastasis and mortality during the follow-up of 258 C-PTC and 153 FVPTC patients who underwent total thyroidectomy were compared. The dynamic risk assessment system was used to refine postoperative risk estimates based on the assessment of response to initial treatment. RESULTS: The demographic data showed no significant difference between the two groups. The mean tumor size showed no significant difference between the two groups. The rate of thyroid capsule invasion, extrathyroidal extension, and lymph node metastasis was significantly higher in C-PTC than in FVPTC group, whereas multicentricity and bilobar involvement were significantly higher in FVPTC group than in C-PTC group. Central lymph node metastasis was significantly more frequent in patients with C-PTC than in those with FVPTC (p < 0.0001). Local recurrence was found in 22 (5.3 %) patients overall and was significantly more common in C-PTC group than in FVPTC group. In patients ≥45 years, the local recurrence rate was significantly higher in patients with CPTC than in those with FVPTC. The local recurrence rate in patients <45 years was not significantly different between the two groups of patients. The multicentricity rate was significantly higher in the FVPTC group for both age groups. Dynamic risk assessment showed that the rate of intermediate- and high-risk groups showed no significant difference between C-PTC and FVPTC patients but the rate of low risk patients was higher in FVPTC group than in C-PTC group (p = 0.04). The recurrence rate in low-risk group was found higher in C-PTC compared to FVPTC patients (4.7 vs. 0.7 %, p = 0.04, respectively). The recurrence rate showed no significant difference in both intermediate- and high-risk groups in C-PTC and FVPTC patients. During the follow-up, the rate of distant metastasis and disease-specific mortality was not significantly different between the two groups (p = 0.25). CONCLUSION: FVPTC is a common subtype of PTC and has a higher rate of multicentricity with bilobar involvement. Although aggressive histopathologic features, such as thyroid capsule invasion, extrathyroidal extension, and lymph node metastasis, are significantly more frequent in CPTC than in FVPTC, the long-term outcome is similar in both subtypes after appropriate initial surgery and postoperative RAI ablation treatment.