IBC Oxford University Oral Abstract 21 - Video abstract: laparoscopic giant hydatid cyst and sleeve gastrectomy surgery

Abstract Introduction Sleeve Gastrectomy despite being the most performed and an effective bariatric surgery is not always straight forward and coexisting pathologies like hydatid cyst liver disease make it more difficult. We present a video of laparoscopic giant hydatid cyst excision with Sleeve Gastrectomy simultaneously. A video presentation will be made, and the technique of surgery will be analysed. Methods The case is a 46-year-old man with BMI of 60 kg/m2 with severe back pain due to a prolapse disc which had not been operated on because of his obesity. He consulted us for weight reduction surgery and was found to have a large hydatid cyst on preoperative ultrasound confirmed by CT abdomen which showed a 20 cm by 20 cm cyst occupying most of the left lobe and some of the central part of the liver. Laparoscopic sleeve surgery was done using 5 trocars. The cyst was punctured and emptied with care to avoiding spillage of the cyst content then part of the cyst excised. After that sleeve gastrectomy done and at the end of the surgery 3 drains were placed; one along the sleeve staple line, one drain adjacent to the cyst and a T tube drain inside the cyst cavity. Results Postoperatively the patient was mobilised 3 hours after the surgery and discharged on day 3 post operatively. The sleeve drain was removed on postoperative day 2, the para-cystic drain on day 10 and the T tube on day 20. The patient was reviewed ion postoperative day 10, day 30 and day 90. At 6 months the patient had lost 60 kg and had no complications related to the cyst drainage and excision. Conclusions Laparoscopic hydatid cyst excision and sleeve gastrectomy can be done effectively if the expertise is available. Further cases and studies are required to support our experience.