Hidatidoza în principalele sale localizări este încă endemică în Romania. În pofida noilor terapii conservatoare – drenajul percutanat ecoghidat sau medicaţia antihelmintică – chirurgia rămâne principalul mijloc de tratament, abordul laparoscopic putând fi eficace în cazuri bine selecţionate. Lucrarea analizează şase observaţii de chist hidatic (CH) cu localizare hepatică (5) respectiv splenică (1) rezolvate cu succes prin tehnici laparoscopice în ultimii trei ani. Este vorba de 5 femei şi un bărbat (CH splenic) cu vârsta medie de 43 (limite: 36-55) ani. Diagnosticul a fost stabilit anamnestic, clinic, serologic, imagistic (ecografic şi prin CT) şi într-un caz intraoperator, obiectivându-se leziuni chistice uniloculare (cu excepţia unei observaţii), necomplicate cu Ø de 5-15 cm şi topografie considerată favorabilă pentru abordul chirurgical minim invaziv. După crearea pneumoperitoneului şi confirmarea diagnosticului, CH hepatice au fost puncţionate transparietal sub videocontrol şi neutralizate iar majoritatea conţinutului lichidian a fost evacuată. În continuare s-a practicat chistotomia, extragerea completă a membranei proligere, excizia adventicei emergente, controlul cavitaţii restante (în cazul chistului dublu, cel de al doilea a fost abordat de manieră similară prin septul despărtitor), toaletă şi drenaj. Pentru localizarea splenică s-a practicat o splenectomie totală. În acest ultim caz ca şi pentru cel mai voluminos CH hepatic a fost necesară o minilaparatomie pentru extragerea piesei. Timpul operator mediu a fost de 90 (limite: 40-200) minute, iar spitalizarea medie de 7 (limite: 4-14 zile) zile. Am înregistrat două complicaţii – şoc anafilactic şi respectiv o colecţie de retenţie – ambele rezolvate. Toate cazurile au evoluat favorabil fără recidive la controalele efectuate la 12-48 luni. În concluzie tratamentul laparoscopic al CH hepatic şi splenic – ca şi cel al altor localizări abdominale – în situaţia unor leziuni univeziculare, necomplicate, de dimensiuni şi topografie convenabilă – poate constitui o alternativă de luat în seamă a chirurgiei deschise.

Hydatid disease is still endemic in our country. In spite of various conservative (percutaneous drainage) or medical (benzimidazol) treatments, surgery remains the mainstay therapy and laparoscopic approach can be successful used in selected cases. Reported here from an ongoing perspective study are six patients (one man and 5 women) with a main age of 43 (range 36-55) years, with abdominal hydatid cysts located in the liver (5) and spleen (1), operated on laparoscopically between 2003-2006 in our clinic. All of them (except a double liver cyst) was solitary, uncomplicated, with a clear content and an average size of 10 (5-15) cm. Diagnosis was based on clinical signs, serology, ultrasonography and computed tomography. After creation of pneumoperitoneum the hepatic cysts was percutaneously punctured through the nearest trocar and after neutralization, majority of fluid content was aspirated without spillage. Then a minimally “en cross” cystotomy was done and a whole extraction of the germinative membrane was achieved. After the video inspection and final toilet we completed the excision of emergent adventicia and drainage of the residual cavity. For the splenic lesion a total laparoscopic splenectomy was performed. In this case as for the hugest hepatic cyst a minilaparatomy for the whole extraction of the piece and germinative membrane was done. Average operative time was 90 (range 40-200) min. One case presented an intraoperative anaphylactic reaction and another one a retention collection resolved by ultrasound guided drainage. The mean hospital stay was 7 (range 4-14) days. All the cases are alive and well without recurrence at the follow-up of 12-48 months. In conclusions the laparoscopic approach of some selected, uncomplicated hydatid cyst with convenable location and volume (around 10 cm) may be in skilled hands a valuable alternative to the open surgery, providing better results, avoiding the morbidity of laparatomy and shortening the hospital stay. A careful evaluation of this technique is mandatory in future in larger series of cases.