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      Laparoscopic hepatectomy for the treatment of hepatic alveolar echinococcosis Translated title: Hépatectomie laparoscopique pour le traitement de l’échinococcose alvéolaire hépatique

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          Background: At present, laparoscopy is relatively mature as a minimally invasive technique, but there are few reports on this approach for the radical treatment of hepatic alveolar echinococcosis (AE). In this study, we aimed to evaluate the safety and feasibility of laparoscopic hepatectomy (LH) for AE treatment. Results: A retrospective review of medical records obtained from 13 patients diagnosed with AE between January 2018 and December 2019 and treated with laparoscopic hepatectomy was conducted at the First Affiliated Hospital of Xinjiang Medical University. All patients ( n = 13) underwent hepatic resection using laparoscopy and none were transferred to open surgery. The average duration of surgery was 285 min (145–580 min). Intraoperative bleeding was 305 mL (20–2000 mL). The mean duration of postoperative catheterization was 6.9 days (3–21 days), and postoperative hospital stay was 7.2 days (4–14 days). No complication of Clavien-Dindo grade III or above occurred, except for the second patient with acute liver failure post-surgically. No recurrences or deaths were observed at 9–30 months of follow-up. Conclusions: Laparoscopic hepatectomy appears to be safe and effective in selected AE patients. The advantages of this technique for AE treatment need to be further compared with the classical open approach.

          Translated abstract

          Contexte : À l’heure actuelle, la laparoscopie est relativement mature en tant que technique minimalement invasive, mais il existe peu de rapports sur cette approche pour le traitement radical de l’échinococcose alvéolaire hépatique (EA). Dans cette étude, nous avons cherché à évaluer la sécurité et la faisabilité de l’hépatectomie laparoscopique pour le traitement des EA. Résultats : Une revue rétrospective des dossiers médicaux obtenus auprès de 13 patients diagnostiqués pour EA entre janvier 2018 et décembre 2019 et traités par hépatectomie laparoscopique a été menée dans le premier hôpital affilié de l’Université médicale du Xinjiang. Tous les patients ( n = 13) ont subi une résection hépatique par laparoscopie et aucun n’a été transféré en chirurgie ouverte. La durée moyenne de la chirurgie était de 285 min (145 à 580 min). Le saignement peropératoire était de 305 ml (20 à 2 000 ml). La durée moyenne du cathétérisme postopératoire était de 6,9 jours (3 à 21 jours) et l’hospitalisation postopératoire était de 7,2 jours (4 à 14 jours). Aucune complication de grade III ou supérieur (Clavien-Dindo) n’est survenue, sauf pour le deuxième patient présentant une insuffisance hépatique aiguë après la chirurgie. Aucune récidive ou décès n’a été observé à 9-30 mois de suivi. Conclusions : L’hépatectomie laparoscopique semble sûre et efficace chez certains patients atteints d’EA. Les avantages de cette technique pour le traitement des EA doivent être mieux comparés à l’approche ouverte classique.

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          Echinococcosis: Advances in the 21st Century

          SUMMARY Echinococcosis is a zoonosis caused by cestodes of the genus Echinococcus (family Taeniidae). This serious and near-cosmopolitan disease continues to be a significant public health issue, with western China being the area of highest endemicity for both the cystic (CE) and alveolar (AE) forms of echinococcosis. Considerable advances have been made in the 21st century on the genetics, genomics, and molecular epidemiology of the causative parasites, on diagnostic tools, and on treatment techniques and control strategies, including the development and deployment of vaccines. In terms of surgery, new procedures have superseded traditional techniques, and total cystectomy in CE, ex vivo resection with autotransplantation in AE, and percutaneous and perendoscopic procedures in both diseases have improved treatment efficacy and the quality of life of patients. In this review, we summarize recent progress on the biology, epidemiology, diagnosis, management, control, and prevention of CE and AE. Currently there is no alternative drug to albendazole to treat echinococcosis, and new compounds are required urgently. Recently acquired genomic and proteomic information can provide a platform for improving diagnosis and for finding new drug and vaccine targets, with direct impact in the future on the control of echinococcosis, which continues to be a global challenge.
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            Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans.

            The earlier recommendations of the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) for the treatment of human echinococcosis have had considerable impact in different settings worldwide, but the last major revision was published more than 10 years ago. Advances in classification and treatment of echinococcosis prompted experts from different continents to review the current literature, discuss recent achievements and provide a consensus on diagnosis, treatment and follow-up. Among the recognized species, two are of medical importance -Echinococcus granulosus and Echinococcus multilocularis - causing cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. For CE, consensus has been obtained on an image-based, stage-specific approach, which is helpful for choosing one of the following options: (1) percutaneous treatment, (2) surgery, (3) anti-infective drug treatment or (4) watch and wait. Clinical decision-making depends also on setting-specific aspects. The usage of an imaging-based classification system is highly recommended. For AE, early diagnosis and radical (tumour-like) surgery followed by anti-infective prophylaxis with albendazole remains one of the key elements. However, most patients with AE are diagnosed at a later stage, when radical surgery (distance of larval to liver tissue of >2cm) cannot be achieved. The backbone of AE treatment remains the continuous medical treatment with albendazole, and if necessary, individualized interventional measures. With this approach, the prognosis can be improved for the majority of patients with AE. The consensus of experts under the aegis of the WHO-IWGE will help promote studies that provide missing evidence to be included in the next update. Copyright 2009 Elsevier B.V. All rights reserved.
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              Diagnosis, treatment, and management of echinococcosis


                Author and article information

                EDP Sciences
                13 January 2021
                : 28
                : ( publisher-idID: parasite/2021/01 )
                [1 ] Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University 830011 Urumqi PR China
                [2 ] State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University 830011 Urumqi PR China
                [3 ] Xinjiang Hydatid & Hepatobiliary Surgery Medical Centre 830054 Urumqi PR China
                Author notes
                [* ]Corresponding author: dr.wenhao@ 123456163.com
                parasite200163 10.1051/parasite/2021001
                © L. Wan et al., published by EDP Sciences, 2021

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 18, Pages: 6
                Research Article


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