Rational Approach to Cyst’s Cavity Sanation in Open Surgery in Children with Hydatid Disease of Liver

V. P. Prytula

Abstract


Despite the wide use of scolexidic drugs and physical methods of influence 17.4-64.0 % of patients after surgical treatment for liver hydatid cysts (LHC) suffered from postoperative complications; and relapse was observed in 7.7-15.0 % of the patients, the main reason of which was drawbacks in the sanation of the cyst’s cavity during the surgery.

The objective of the study was the development and practical implementation of new methods of cysts’ sanation in the open surgery in children with hydatid disease of liver.

Materials and methods. The treatment of 212 children with 353 LHC was conducted. All patients were treated conservatively (n=20), by the open surgery (laparotomy) (n=164), by miniinvasive surgery - puncture-drainage (transcutaneous puncture) (n=25) and laparoscopically (n=3).

Results and discussion. The method of LHC sanation in open surgery (Patent of Ukraine № 64726) was offered. It consists in the fact that laparotomy was performed and the cyst’s content was punctured and aspirated, after that 10 % alcoholic iodine solution and 96 % ethanol and 0.02 % solution of chlorhexidine bigluconate was injected in the cyst’s cavity with 7 minutes exposure followed by exsufflation. After the cyst’s cavity opening and removing of the chitinous membrane, cavity of the cyst was additionally treated with tampons alternately soaked in 10 % alcoholic iodine solution, 96 % ethanol and 0.02 % chlorhexidine bigluconate for 5 minutes each.

Conclusion. Due to the creation of optimal conditions for increasing the reliability of the LHC antiparasitic treatment with open surgery by taking into account the pharmacological properties of germicides and anatomical and physiological characteristics of the liver and of the whole body in this condition, it was possible to prevent the postoperative complications and recurrence of the disease leading to successful treatment.


Keywords


liver hydatid cyst; treatment; outcomes; children

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