Evaluation of the factors influencing the choice of laparoscopic echinococcectomy in liver echinococcosis (LE) and its impact on postoperative outcomes.

The aim of this article is to evaluate the factors influencing the choice of laparoscopic echinococcectomy (LapEE) in liver echinococcosis (LE) and its impact on postoperative outcomes. The article presents a retrospective analysis of the effectiveness of LapEE depending on gender, age, cyst location, size and stage of echinococcal cysts (EC) development, also taking into account the performance of drainage or abdominal interventions in relation to the residual cavity (RC). The study included patients with the primary form of LE - 46 patients who underwent LapEE at the State Institution "Republican Specialized Scientific and Practical Medical Center for Surgery, named after the academician V. Vakhidov", between 2019 and 2020. Taking into account the stage of cyst development, various difficulties with aspiration or removal of the cyst contents occurred in only 14 (30.4%) cases, more often with type II-IV cystic echinococcosis (CE). Another problem was the difficulty with adequate revision and treatment of RC (in 6 (13.0%) patients) with predominantly intraparenchymal localization. Difficulties with performing percytectomy with sufficient excision of the fibrous capsule were noted in 9 (19.6%) cases. In the period up to a week after the operation, the drainage was removed for cysts up to 8 cm in 11 (36.7%) cases, with more than 8 cm - in 5 (31.3%). By 3 weeks of observation, the drains were removed in all cases with cysts up to 8 cm, while with large sizes in 12.5% (2 patients) cases, the drainage was removed on days 21-28 and in 1 (6.3%) patient at a later period. In general, in the group, complications from the RC on days 9-27 after LapEE were noted in 10 (21.7%) of 46 patients, fluid accumulation in 8 (17.4%) and suppuration in 2 (4.3%). Most complications were resolved conservatively - 13.0% (in 6 patients), a minimal invasive drainage of the RC was performed in 6.5% (3 patients), 1 (2.2%) patient was operated on with a RC abscess. Among the main factors that technically complicate LapEE, in addition to localization, difficulties with aspiration or removal of cyst contents in CE II, III, and IV are highlighted due to the presence of many daughter cysts that completely fill the maternal membrane (CE II, III) or thick viscous discharge (CE IV), as well as difficulties in performing a pericystectomy for adequate elimination of the RC when the hydatid is located 3/4 or more in the liver parenchyma.

Surgical treatment of liver echinococcosis.

This article is based on the treatment results of primary and recurrent epidural infection among 1230 patients treated at three medical institutions: Khorezm Regional Multidisciplinary Medical Center, Clinic of Andijan State Medical Institute, Republican Specialized Scientific and Practical Medical Center for Surgery, between 2015-2020. The comparison group included 621 patients (from 2015 to 2017) who underwent a retrospective analysis. In comparison, the main group of the study included 609 patients (from 2018 to 2020). In the main group of patients, traditional echinococcectomy (EE) was performed in 80.1% of cases, LapEE in 12.3%, and PAIR and PEVAC techniques in 7.6%. The overall incidence of complications from the residual cavity in the comparison group was 36.4% after the PAIR technique, 39.1% after the PEVAC technique, 21.7% after LapEE, and 6.9% (37 out of 503) after traditional and resection EE. The proposed algorithm for selecting a method for treating exocrine pancreatic insufficiency (EPI) made it feasible to optimize tactical approaches to perform traditional and minimally invasive interventions, which ensured a decrease in the incidence of complications from the residual cavity and, accordingly, the need for repeated minimally invasive and open interventions and conservative therapy.

Epidemiological aspects of echinococcosis of the liver and other organs in the Republic of Uzbekistan.

INTRODUCTION: Recently, in international medical organizations, more and more interest is shown towards diseases in humans, among which the cystic form of echinococcosis (CE) is given special importance. As a zoonotic parasitic disease caused by the larval stage of cestodes belonging to the genus Echinococcus and the Taeniidae family, CE in 2014 was recognized globally by the UN Food and Agriculture Organization (FAO) and WHO as the second most important foodborne parasitic pathology. In the 2018, the European Food Safety Authority (EFSA) considered CE among the food-borne parasites of highest relevance in Europe. PURPOSE: to study the actual epidemiology of human echinococcosis lesion in the Republic of Uzbekistan for 2015-2019 to highlight the mean annual incidence of this pathology in all regions of the country, as well as the extensive value of the proportion of echinococcosis of the liver (EL), lungs (LE) and other localizations. MATERIAL AND METHODS: The officially registered data for all regions of the country for 2015-2019 were studied. An ultrasound screening of the abdominal organs of the population of the Khorezm region was carried out during 2019 to determine the effectiveness of early diagnosis of EL. A total of 104,284 inhabitants were examined, of which 38,660 were children and 65,624 were adults. RESULTS: According to the processed statistical data for all regions of the Republic of Uzbekistan for 2015-2019 on average, 2105.0 ± 43.3 patients with echinococcosis of various localizations were diagnosed. The mean annual incidence was 6.5 ± 0.09 per 100,000 inhabitants. The extensive value of the EL share was 79.4 ± 0.9% (1672.2 ± 35.6 on average per year), high-level rate - 5.2 ± 0.08 per 100,000 inhabitants; the proportion of LE was 14.0 ± 0.8% (295.2 ± 17.8), the prevalence was 0.9 ± 0.06 per 100,000 inhabitants; the proportion of echinococcosis of other localizations was 6.5 ± 0.5% (137.6 ± 13.4), the high-level value was 0.4 ± 0.03 per 100,000 inhabitants. The frequency of detection of the liver or other abdominal organs echinococcosis during screening ultrasound in the Khorezm region was 0.009%, in turn, the examination of family members of these patients increased this indicator to 0.011%.