Splenic Surgery for Hydatid Spleen in Single Institutional Experience
Condition: Spleen; Cyst, Hydatid (Manifestation)
MeSH terms: Echinococcosis
Study type: Observational

Summary: 
      Splenic-preserving surgery in hydatid spleen: Single intuitional experience
    

Detailed description: 
      Background:

      Although hydatid disease affects many organs in the human body, splenic hydatid represents
      about 0.8-4% of all human echinococcosis cases. Until recently, splenectomy was the
      recommended surgical procedure for splenic hydatid. Since 1980 there has been an increasing
      tendency to use conservative option to deal with such pathology.

      Aim of the study:

      To evaluate our experience in open splenic-preserving surgery for splenic hydatid in a single
      institutional study.

      Patient and methods:

      A retrospective study. Ten patients with splenic hydatid were operated upon from August 2013
      to January 2018 in our medical centre. Spleen has affected alone in 7 cases, liver and spleen
      were affected in 3 cases, and one of them had intraperitoneal cyst affection in addition. The
      diagnosis confirmed mainly by ultrasonography. In some cases, it computed tomography CT scan,
      and magnetic resonance imaging MRI were needed. Chest X-ray had taken for all patients to
      exclude pulmonary hydatid. The open surgical procedure used. Isolation of the field,
      aspiration of cystic fluid and injection of 1% cetrimide solution, re-aspiration,
      endocystectomy, suturing of cystic edges over intracystic tube drain. All surgery did under
      cover of albendazole pre and postoperative 15mg/kg/day.

      Results:

      No significant intraoperative and postoperative complications. No reoperation was needed.
      Hospital stays 3-5 days. No recurrence after (1-3) year follow-up. However, three patients
      missed follow-up after two years.

      Conclusion:

      Our experience in splenic hydatid encourages us to use splenic-preserving surgery whenever
      possible instead of splenectomy.
    

Intervention name(s): Cystic enculation of spleen hydatid
Intervention type(s): Procedure
Intervention description(s): Preoperative preparation did according to the general condition of the patient and fitness for anaesthesia. Laparotomy did under general anaesthesia, supine position, the abdomen opened either by midline or left subcostal incision. Identification of splenic hydatid cyst. Exploration of the peritoneal cavity for undetected hepatic or peritoneal hydatid preoperatively. Isolation of operative field by packs socked with hypertonic solution (20 -30 % hypertonic saline). Aspiration of the cyst fluid. Injection of suitable amount about 5 ml of (1 % of cetramid) solution and waiting for at least 5 minutes and then re-aspiration. The spleen is not needed to mobilize. Extraction of the endocyst and washing of the cavity with normal saline. Occupying the cystic cavity intracystic drain. Perioperative and postoperative close observation of the patient for an anaphylactic reaction or any other complication. Follow-up of the patient until discharge from hospital on (3th - 5th) days.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        from 5- 40 years (mean 23.6 years).
      
Keywords: Spleen; Hydatid cyst; Surgery; Preserving surgery