Vest-over-Pant Method for Closure of Residual Cavity of Liver Hydatid Cyst

Objective. Although several therapeutic strategies have proven to be effective for hydatid cyst of liver, but surgery is still the most common therapy despite its morbidity and mortality. Furthermore, a variety of technique has been recommended for managing the residual cavity after cystectomy. We report here a new technical method for the reconstruction of hydatid cyst residual cavity with using overlapping flaps of liver edges (Vest over Pant). Methods. In this technique after removing the cyst, the edges of one side of cyst cavity were sutured to the base of the cavity using three to four mattress sutures), and edges of other side of liver was overlapped on the dorsal part of previous layer using four to five mattress sutures. Therefore residual cavity dead space was obliterated with two surfaces of cavity. Results. Fifty males were treated by our method. The average cyst volume was ？mL. There was no intraabdominal sepsis, bile leakage, or hepatic necrosis. In follow-up ultrasound study, residual cavities were disappeared one month after operation. Conclusion. Overlapping flaps of liver edges (Vest over Pant) provides easy, safe closure of cyst with preservation of the liver anatomy. 1. Introduction The appropriate treatment for hydatid cyst of the liver [1] is determined by several factors such as the patient, the cyst, the therapeutic resources, and the physician. Although several therapeutic strategies have proven to be effective for hydatid cyst of liver [2, 3], surgery is still the most common therapy despite its morbidity and mortality [4]. Furthermore, a variety of techniques have been recommended for managing the residual cavity after cystectomy [5–11], but none of these methods is universally applicable [12]. We report a modified technique for introflexion of hydatid cyst residual cavity with using overlapping flaps of liver edges (vest over pant). 2. Method This clinical prospective study was approved by the ethical committee of our university. Participants were all patients consecutively admitted to the general surgery unit of the study hospital for elective surgery of liver hydatid cyst. 2.1. Operative Technique In approach to liver hydatid cyst, we perform laparotomy with transverse right subcostal incision. Liver mobilization of right hepatic lobe exposing the bare area is performed by dissection of hepatic diaphragmatic attachments. In addition, division of the falciform ligament and peritoneal attachments to the left lateral segment are completed. Operative field is isolated with abdominal packs soaked with 0.5% AgNO3. After that, we