Surgical treatment of liver hydatic cyst and evaluation of cystobiliary fistula: experience of two centers

Authors : Hayrettin DİZEN, Berrin YALINBAŞ KAYA

Pages : 942-948

Doi:10.32322/jhsm.1112941

View : 29 | Download : 8

Publication Date : 2022-07-20

Article Type : Research Paper

Abstract :Objective: Intrabiliary rupture or cystobiliary fistula is the most common complication of hepatic hydatid cyst. In this article, our objective is to evaluate the clinical, laboratory, imaging, surgical treatment and results of cystobiliary fistulas, which is the most common complication of hydatid cysts. Material and Method: In our study, patients who underwent open surgery and were followed up and treated for hydatid cyst in the gastroenterology and general surgery outpatient clinic and service between years 2015-2021 were included. The clinical, laboratory, radiological and surgical results of 171 patients with hydatid cysts were retrospectively analyzed. Results: The mean age of 171 patients who underwent surgery for hydatid cyst was 44.8 insert ignore into journalissuearticles values(18-71);, 68 of whom were men and 103 were women. Bile leakage was present in 50 patients insert ignore into journalissuearticles values(50 insert ignore into journalissuearticles values(29.23%););. There were 24 insert ignore into journalissuearticles values(48%); men and 26 insert ignore into journalissuearticles values(52%); women with bile leakage. The cyst diameter was 74.2 insert ignore into journalissuearticles values(36-170); mm and the number of cysts was 1.2 insert ignore into journalissuearticles values(1-2);. The cysts were located in the right lobe of the liver in 116 insert ignore into journalissuearticles values(79%); patients, in the left lobe in 30 insert ignore into journalissuearticles values(15%); patients, and in both lobes in 25 insert ignore into journalissuearticles values(6%); patients. Cystobiliary fistula developed more frequently, especially in cysts located in the right lobeinsert ignore into journalissuearticles values(36 insert ignore into journalissuearticles values(72%););. Cystobiliary fistula was most common in CE3 insert ignore into journalissuearticles values(Gharbi type 2); type insert ignore into journalissuearticles values(30 insert ignore into journalissuearticles values(60%););. Cystectomy+drainage was performed in 137 insert ignore into journalissuearticles values(80%); patients in all groups. Cystectomy and drainage were the most common surgical procedures. The cyst diameter was 10 cm in the group with cystobiliary fistula and was significant compared to the group without fistula insert ignore into journalissuearticles values(p<0.001);. Aminotransferase insert ignore into journalissuearticles values(AST and ALT); levels were high in patients with cystobiliary fistula insert ignore into journalissuearticles values(p=0.012, p=0.054);. However, there was no significant difference between the two groups in alkaline phosphatase, total bilirubin, and gamma glutamyl transferase insert ignore into journalissuearticles values(p=0.231, p=0.097, p=0.544);. Conclusion: Liver hydatid cyst is endemic in our country as well as in many other countries in the world. Complicated hepatic hydatid cysts require timely and appropriate treatment because of their life-threatening complications. Cytobiliary fistula is the most common complication. In the surgical treatment of hydatid cyst disease, the earlier the diagnosis of occult cystobiliary fistulas is made insert ignore into journalissuearticles values(especially in the preoperative or peroperative period);, the easier the treatment is, and the risk of bile leakage and consequently the morbidity and mortality decreases. Our results and experience showed that treatment and complications are related to the location and size of the cyst, occult/large cystobiliary fistula, detectability of occult fistulas, experienced center and surgeon.
Keywords : Liver hydatid cyst, surgical treatment, cystobiliary fistula