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Jarrar MS, Karmani I, Chahed M, Barka M, Mraidha MH, Toumi R, Beizig A, Dhouioui K, Youssef S. Preoperative predictive factors of cystobiliary fistulas in liver hydatid cysts: results of a monocentric study. Future Sci OA 2025; 11:2458420. [PMID: 39871603 PMCID: PMC11776849 DOI: 10.1080/20565623.2025.2458420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 12/26/2024] [Indexed: 01/29/2025] Open
Abstract
INTRODUCTION The evolution of hepatic hydatid cyst can be enameled with complications, mainly biliary fistula, which can be both symptomatic or occult. The aim of this study is to identify the predictive factors of occult cysto-biliary communication. MATERIAL AND METHODS This is a retrospective study of patients operated-on for uncomplicated hepatic hydatid cyst in Farhat Hached Hospital of Sousse over a period of 10 years. RESULTS Two hundred twenty patients were operated-on for uncomplicated hydatid cyst. In univariate analysis, alkaline-phosphatase, gamma-glutamyl-transferase, alanine-transferase elevated levels and multiple type were factors associated with occult fistula, but gamma-glutamyl-transferase level was the only predictor in multivariate analysis. CONCLUSION These predictive factors could contribute to determine preoperative probability of occult fistula, thus indicating additional intraoperative procedures to ensure its identification.
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Affiliation(s)
- Mohamed Salah Jarrar
- Department of General and Digestive Surgery, Farhat Hached University Hospital - Sousse, Sousse, Tunisia
- University of Sousse, Sousse, Tunisia
| | - Ines Karmani
- Department of General and Digestive Surgery, Farhat Hached University Hospital - Sousse, Sousse, Tunisia
- University of Sousse, Sousse, Tunisia
| | - Mehdi Chahed
- Department of General and Digestive Surgery, Farhat Hached University Hospital - Sousse, Sousse, Tunisia
- University of Sousse, Sousse, Tunisia
| | - Malek Barka
- Department of General and Digestive Surgery, Farhat Hached University Hospital - Sousse, Sousse, Tunisia
- University of Sousse, Sousse, Tunisia
| | - Mohamed Hedi Mraidha
- Department of General and Digestive Surgery, Farhat Hached University Hospital - Sousse, Sousse, Tunisia
- University of Sousse, Sousse, Tunisia
| | - Radhouane Toumi
- University of Sousse, Sousse, Tunisia
- Intensive Care Unit, Farhat Hached University Hospital - Sousse, Sousse, Tunisia
| | - Ameni Beizig
- University of Sousse, Sousse, Tunisia
- Emergency Department, Regional Hospital of Kasserine, Kasserine, Tunisia
| | - Khayri Dhouioui
- Department of General and Digestive Surgery, Farhat Hached University Hospital - Sousse, Sousse, Tunisia
- University of Sousse, Sousse, Tunisia
| | - Sabri Youssef
- Department of General and Digestive Surgery, Farhat Hached University Hospital - Sousse, Sousse, Tunisia
- University of Sousse, Sousse, Tunisia
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Das CJ, Venkatesh SSK, Gupta S, Sharma R, Agarwal D, Kundra V. Abdominal hydatid disease: role of imaging in diagnosis, complications, and management. Abdom Radiol (NY) 2025:10.1007/s00261-025-04957-1. [PMID: 40249553 DOI: 10.1007/s00261-025-04957-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 04/08/2025] [Accepted: 04/11/2025] [Indexed: 04/19/2025]
Abstract
Hydatid disease is a relatively common parasitic infection. Incidence can reach more than 50 per 100,000 person-years in endemic areas. It can affect all organs but favors the liver and lungs. Presentation is often asymptomatic. Imaging plays a crucial role in diagnosis in conjunction with serology. Primary evaluation is usually by ultrasound, often followed by CT or MRI, to understand disease extent, including lesion size, internal architecture, multiplicity, location, and adjacent structure involvement. CT better detects lesion calcifications. MRI is advantageous for certain complications such as biliary communication. Cystic lesions with membranes or daughter cysts are highly indicative of hydatid disease. In comparison, diagnosis during the inactive stage can pose challenges at imaging and often also requires tissue sampling. Due to varying appearances at different developmental stages, hydatid disease can mimic various pathologies ranging from cysts to malignancy. Image-guidance aids management. Treatment is based on cyst type, size and location; with uncomplicated cysts typically amenable to PAIR (puncture, aspiration, injection, and re-aspiration) or modified catheterization technique (MoCAT) using scolicidal agents. In contrast, surgical intervention is required for complicated cysts such as those located in a hepatic subcapsular location, those that exhibit biliary communication, or have ruptured.
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Affiliation(s)
- Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - S S K Venkatesh
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanchita Gupta
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Divij Agarwal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Kundra
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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Lissandrin R, Cicerone O, Vola A, D'Alessandro G, Frassini S, Manciulli T, Famularo S, De Silvestri A, Viganò J, Quaretti P, Ansaloni L, Brunetti E, Maestri M. Machine learning to predict the decision to perform surgery in hepatic echinococcosis. HPB (Oxford) 2025; 27:480-488. [PMID: 39755481 DOI: 10.1016/j.hpb.2024.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 12/17/2024] [Accepted: 12/17/2024] [Indexed: 01/06/2025]
Abstract
BACKGROUND Cystic echinococcosis (CE) is a significant public health issue, primarily affecting the liver. While several management strategies exist, there is a lack of predictive tools to guide surgical decisions for hepatic CE. This study aimed to develop predictive models to support surgical decision-making in hepatic CE, enhancing the precision of patient allocation to surgical or non-surgical management pathways. METHODS This retrospective analysis included 406 hepatic CE patients treated at our center (2009-2021). Clinical, imaging, and treatment data were used to develop a Cox regression and a decision tree model to identify factors influencing surgical intervention, with model performance validated using K-fold cross-validation, train/test split, bootstrapping. RESULTS Imaging findings and symptomatology emerged as the most significant predictors. The Cox model demonstrated a concordance index of 0.94 and an AUC of 0.96, while the decision tree model identified imaging, cyst stage, and symptoms as critical factors, achieving strong performance across validation techniques (mean AUC 0.950; 95% CI: [0.889, 0.978]). CONCLUSION This study presents validated predictive models for assessing surgical risk in hepatic CE. Integrating these models into clinical practice offers a dynamic tool that surpasses static guidelines, optimizing patient allocation to surgical or non-surgical pathways and potentially improving outcomes.
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Affiliation(s)
| | - Ottavia Cicerone
- University of Pavia, Dipartimento di Scienze Clinico-chirurgiche, Diagnostiche e Pediatriche, Italy
| | - Ambra Vola
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Simone Frassini
- University of Pavia, Dipartimento di Scienze Clinico-chirurgiche, Diagnostiche e Pediatriche, Italy
| | - Tommaso Manciulli
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - Simone Famularo
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Annalisa De Silvestri
- SSD Biostatistica E Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jacopo Viganò
- Fondazione IRCCS Policlinico San Matteo, SC Chirurgia Generale 1, Pavia, Italy
| | - Pietro Quaretti
- Fondazione IRCCS Policlinico San Matteo, SS Radiologia Interventistica, Pavia, Italy
| | - Luca Ansaloni
- University of Pavia, Dipartimento di Scienze Clinico-chirurgiche, Diagnostiche e Pediatriche, Italy; Fondazione IRCCS Policlinico San Matteo, SC Chirurgia Generale 1, Pavia, Italy
| | - Enrico Brunetti
- Fondazione IRCCS Policlinico San Matteo, SC Malattie Infettive, Pavia, Italy; University of Pavia, Dipartimento di Scienze Clinico-chirurgiche, Diagnostiche e Pediatriche, Italy
| | - Marcello Maestri
- Fondazione IRCCS Policlinico San Matteo, SC Chirurgia Generale 1, Pavia, Italy.
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Manterola C, Rivadeneira J, Otzen T, Rojas-Pincheira C. Hepato-thoracic cystic echinococcosis transit. Clinical features, postoperative complications and hospital mortality. A systematic review. HPB (Oxford) 2025; 27:330-342. [PMID: 39730217 DOI: 10.1016/j.hpb.2024.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 11/25/2024] [Accepted: 12/02/2024] [Indexed: 12/29/2024]
Abstract
BACKGROUND Hepato-thoracic hydatid transit (HTT) is an evolutionary complication of hepatic cystic echinococcosis. This study aimed to report the available evidence regarding postoperative complications (POC) and hospital mortality (HM). METHODS Systematic review. Studies related to HTT were included. Searches were performed in Trip Database, SciELO, BIREME-BVS, WoS, PubMed, EMBASE and SCOPUS. PRIMARY OUTCOMES POC and HM. SECONDARY OUTCOMES publication date, origin and designs, number of patients, cyst type, hospital stance, treatments; and methodological quality (MQ) of studies applying MInCir-T and MInCir-Pr2 scales. Descriptive statistics, weighted means (WM) and their comparison using least squares logistic regression, and meta-analysis of prevalence of POC and HM were applied. RESULTS 604 studies were retrieved (101 met selection criteria, representing 1020 patients). WM age: 42.6 years, 58.3 % male. Reports are mainly from Spain (19.8 %) and Turkey (17.8 %). With a WM of 18.3 days of hospital stance, it was verified 28.9 % of POC, 12.6 % needed re-interventions, and 9.7 % died. MQ of studies: 9.1 ± 1.9 (MInCir-T) and 13.2 ± 2.9 (MInCir-Pr2). Comparing the behavior of variables in two periods (1983-2002 vs. 2003-2024), statistically significant differences were observed in POC, HM, and reinterventions. CONCLUSION HTT is associated with high POC, and significant HM, despite the passage of time.
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Affiliation(s)
- Carlos Manterola
- Center for Morphological and Surgical Studies, Universidad de La Frontera, Chile; Department of Surgery, Universidad de La Frontera, Chile; PhD. Program in Medical Science, Universidad de La Frontera, Chile.
| | - Josue Rivadeneira
- PhD. Program in Medical Science, Universidad de La Frontera, Chile; Zero Biomedical Research, Quito, Ecuador
| | - Tamara Otzen
- PhD. Program in Medical Science, Universidad de La Frontera, Chile
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Baykan AH, Aydin E, Koc M, Sahin H, Karul A, Baykan ME, Ikizceli T, Erturk SM. Hydatid disease: imaging, treatment, and beyond. Clin Radiol 2025; 80:106748. [PMID: 39631363 DOI: 10.1016/j.crad.2024.106748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 11/02/2024] [Accepted: 11/04/2024] [Indexed: 12/07/2024]
Abstract
Hydatidosis is an endemic parasitic disease that can occur in almost any part of the body. It presents in two different forms according to the type of tapeworm: Echinococcus granulosus (hydatid disease [HD]) and Echinococcus multilocularis (alveolar HD). Radiological imaging can reveal the type of cyst, disease activity and progression, and complications, with features depending on the HD stage, the organ involved, and complications. Radiological imaging is also used to plan treatment strategies and evaluate patients at follow-up. Here, we review the morphologies of different HD presentations and their radiological features, the diagnostic findings that suggest possible HD in rare sites, and the potential complications of HD. We also discuss the role of radiology in hydatidosis diagnosis and treatment.
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Affiliation(s)
- A H Baykan
- Adiyaman University Faculty of Medicine, Department of Radiology, Adiyaman, Turkey.
| | - E Aydin
- Department of Radiology, Tepecik Training and Research Hospital, 35110, Yenisehir, Izmir, Turkey.
| | - M Koc
- Firat University Faculty of MedicineDepartment of Radiology, Elazig, Turkey.
| | - H Sahin
- Department of Radiology, Tepecik Training and Research Hospital, 35110, Yenisehir, Izmir, Turkey.
| | - A Karul
- Adiyaman University Faculty of Medicine, Department of Radiology, Adiyaman, Turkey.
| | - M E Baykan
- Haci Omer Tarman High School, Ankara, Turkey.
| | - T Ikizceli
- University of Health Sciences, Department of Radiology, Istanbul, Turkey.
| | - S M Erturk
- Istanbul University Faculty of Medicine, Department of Radiology, Istanbul, Turkey.
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Aydın İC, İlhan N, Şeker A, Ofluoğlu CB, Mülküt F, Göret NE, Çetin K, Polat E, Aygün G, Kücük HF. SCOLICIDAL POTENCY OF BILE AGAINST ECHINOCOCCUS GRANULOSUS. J Parasitol 2025; 111:64-69. [PMID: 39937536 DOI: 10.1645/24-111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2025] Open
Abstract
Cysto-biliary fistulas are commonly diagnosed, either before or after surgical intervention, in patients with enlarged or advanced-stage hydatid cysts (HCs). Analysis of cystic contents in these patients shows that diminished scolex vitality is more common in patients with cysto-biliary fistulas. This study aims to demonstrate the scolicidal effects of bile on Echinococcus granulosus (EG) scolices at various bile concentrations and over specific periods. The time- and concentration-based scolicidal potency was analyzed in EG scolex samples obtained from HC patients. The integrity of the cyst wall and the scolicidal effect of the contents were evaluated using a vital staining technique with 0.1% eosin. Bile samples were collected from patients with cholelithiasis who were scheduled for surgery. Scolicidal efficacy of 100% was observed in all samples at the 1/4 bile concentration after 10 min and at the 1/8 concentration after 60 min. At a 1/16 concentration, scolicidal efficacy was 66% at 1 min, 89% at 10 min, 93% at 30 min, and 98% at 60 min. At a 1/32 bile concentration, scolicidal efficacy was 59% at 1 min, 68% at 10 min, 89% at 30 min, and 95% t 60 min. At a 1/64 concentration, the scolicidal efficacy was 53% at 1 min, 58% at 10 min, 77% at 30 min, and 93% at 60 min. After 1 hr, reasonable scolicidal efficacy was determined up to a 1/64 concentration; however, significant decreases in scolicidal efficacy were observed at 1/128 and 1/256 bile concentrations. Theoretically, bile, which is an endogenous secretion, can be used as a suitable and potent scolicidal agent. This study lays the groundwork for future in vivo clinical trials utilizing synthetic bile acids for scolicidal purposes or for studies evaluating the scolicidal effects of bile in patients who develop cysto-biliary fistulas.
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Affiliation(s)
- İsa Caner Aydın
- Ministry of Health Zonguldak Atatürk State Hospital, Department of Gastrointestinal Surgery, 67030, Zonguldak, Turkey
| | - Noyan İlhan
- University of Health Sciences, Istanbul Kartal Dr. Lütfi Kırdar City Hospital, Department of General Surgery, 34865, Istanbul, Turkey
| | - Ahmet Şeker
- University of Health Sciences, Adana City Hospital, Department of Gastrointestinal Surgery, 01370, Adana, Turkey
| | - Cem Batuhan Ofluoğlu
- University of Health Sciences, Sancaktepe Dr. İlhan Varank Training and Research Hospital, Department of General Surgery, 34785, Istanbul, Turkey
| | - Fırat Mülküt
- University of Health Sciences, Sancaktepe Dr. İlhan Varank Training and Research Hospital, Department of General Surgery, 34785, Istanbul, Turkey
| | - Nuri Emrah Göret
- Ministry of Health Bakircay University İzmir Çiğli Training and Research Hospital, Department of General Surgery, 35620, İzmir, Turkey
| | - Kenan Çetin
- Çanakkale 18 Mart University, Faculty of Medicine, Department of General Surgery, 17020, Çanakkale, Turkey
| | - Erdal Polat
- Istanbul University-Cerrahpaşa, Faculty of Medicine, Department of Microbiology, 34098, Istanbul, Turkey
| | - Gökhan Aygün
- Istanbul University-Cerrahpaşa, Faculty of Medicine, Department of Microbiology, 34098, Istanbul, Turkey
| | - Hasan Fehmi Kücük
- University of Health Sciences, Istanbul Kartal Dr. Lütfi Kırdar City Hospital, Department of General Surgery, 34865, Istanbul, Turkey
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Erkmen F, Yilmaz M, Yonder H, Tatli F, Ozgonul A, Karaca E, Batibay E, Uzunkoy A. Complications and management of patients with liver hydatid cyst: A single center experience. HEPATOLOGY FORUM 2024; 6:52-56. [PMID: 40248675 PMCID: PMC11999902 DOI: 10.14744/hf.2024.2024.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 11/21/2024] [Accepted: 12/02/2024] [Indexed: 04/19/2025]
Abstract
Background and Aim Hydatid cysts are caused by Echinococcus larvae and are prevalent in endemic areas worldwide. We analyzed post-procedure complications and outcomes of patients with liver hydatid cysts. Materials and Methods We included patients who were managed either by surgery or percutaneous drainage (PAIR) for hydatid liver cysts at Harran University Faculty of Medicine Hospital between January 2017 and February 2021. We recorded age, sex, segmental location, size, number, Gharbi classification, treatment modality, length of hospital stays, and complications. Results We included a total of 209 patients who were managed by hydatid liver cysts. Among them, 74 post-procedural complications were developed in a total of 69 (33%) patients. Biliary fistula was the most prevalent complication (n=38,18.2%). Hospitalization duration was a median of 5 days (2-36) and was 5 days (2-36) in patients who underwent surgery and 3 days (range:2-7) in patients managed by PAIR. Patients with cyst diameter ≥9.5 cm were predicted to have an increased risk of complications with 70% sensitivity and 60% specificity. More patients experienced any difficulties in patients who were managed by PAIR than those who underwent surgery (65.4% vs 28.4%, p<0.001). Conclusion Our study showed that both surgery and PAIR are safe and effective management strategies for patients with liver cyst hydatid. PAIR was associated with more complications but a shorter duration of hospitalization.
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Affiliation(s)
- Firat Erkmen
- Department of General Surgery, Health Sciences University Mehmet Akif Inan Hospital, Sanliurfa, Turkiye
| | - Mehmet Yilmaz
- Department of General Surgery, Dicle University School of Medicine, Diyarbakir, Turkiye
| | - Huseyin Yonder
- Department of General Surgery, Harran University School of Medicine, Sanliurfa, Turkiye
| | - Faik Tatli
- Department of General Surgery, Harran University School of Medicine, Sanliurfa, Turkiye
| | - Abdullah Ozgonul
- Department of General Surgery, Harran University School of Medicine, Sanliurfa, Turkiye
| | - Emre Karaca
- Department of General Surgery, Sanliurfa Training and Research Hospital, Sanliurfa, Turkiye
| | - Ersin Batibay
- Department of Gastroenterology, Harran University School of Medicine, Sanliurfa, Turkiye
| | - Ali Uzunkoy
- Department of General Surgery, Harran University School of Medicine, Sanliurfa, Turkiye
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Gümüşoğlu AY, Kabuli HA, Değerli MS, Atar B, Köneş O, Kocataş A, Bingül ND, Dolay K. Endoscopic definitive treatment of liver hydatid cysts ruptured into bile duct. Surg Endosc 2024:10.1007/s00464-024-11305-9. [PMID: 39367134 DOI: 10.1007/s00464-024-11305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 09/22/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND Intrabiliary rupture (IBR) is one of the most common complications of hepatic hydatid cysts (HHC),and the surgical treatment of major intrabiliary rupture (MIBR) leads to serious morbidity and mortality. This study aimed to evaluate the efficacy of endoscopic definitive treatment of these patients. METHODS This study included 38 patients who underwent ERCP for MIBR between 2004 and 2022. Endoscopic sphincterotomy (ES) was performed, followed by evacuation of hydatid contents from the main bile ducts and cyst cavity. A nasobiliary drainage (NBD) catheter was placed inside the cyst cavity in 15 patients, while biliary stenting (BS) was performed in 23 patients. Demographic data, cyst characteristics, hospital stay, complications, treatment success, and recurrence were analyzed. RESULTS The mean age of patients was 46.5 years, with 12 female and 26 male. All patients had WHO-type-3B hydatid cysts with an average diameter of 7.9 cm. NBD was continued for definitive purposes in 13 of the 15 patients who underwent NBD, and full cure was achieved in 13 patients. Among the 23 patients who underwent biliary stenting (BS), 16 (69.5%) required a second ERCP due to jaundice or cholangitis, and 6 (26%) underwent percutaneous drainage due to hydatid cavity infection. The average length of hospital stay was 16.13 days in the BS group, while it was 8.3 days in the NBD group.The average follow-up period was 23 months. All patients achieved complete recovery. CONCLUSIONS The endoscopic approach is an effective and safe method for the treatment of MIBR, and can be considered as a definitive treatment option in centers with adequate resources and experienced endoscopists.
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Affiliation(s)
- Alpen Yahya Gümüşoğlu
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hamit Ahmet Kabuli
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mahmut Said Değerli
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Burak Atar
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Osman Köneş
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali Kocataş
- Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Nilsu Damla Bingül
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Kemal Dolay
- Department of General Surgery and Intestinal Endoscopy, Dolay Clinic, Istanbul, Turkey.
- Hakkı Yeten Caddesi, Aşçıoğlu Plaza:17 Beşiktaş, 34349, İstanbul, Turkey.
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Trigui A, Fendri S, Saumtally MS, Akrout A, Trabelsi J, Daoud R, Toumi N, Ketata S, Boujelbene W, Mzali R, Dziri C, Ben Amar M, Boujelben S. Standardized approach to the conservative surgery of hepatic cystic echinococcosis: A prospective study. PLoS Negl Trop Dis 2024; 18:e0012289. [PMID: 38924053 PMCID: PMC11232992 DOI: 10.1371/journal.pntd.0012289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 07/09/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Surgery is the mainstay of hepatic cystic echinococcosis (HCE). The conservative surgery of HCE carries a non-negligible risk of recurrence and significant morbidity, dominated by Deep Surgical Site Infections (DSSI). To address these issues, we have improved and standardized this technique, which could reduce complications and achieve better postoperative outcomes. PATIENTS AND METHODS We conducted a prospective study from June 2017 to June 2022 involving of patient operated using a standardized open technique for uncomplicated HCE at Habib Bourguiba University Hospital, Sfax, Tunisia. The aim was to obtain results at least similar to radical management in terms of DSSI. Patients with large cystobiliary fistulas or patients with complicated cysts were excluded. RESULTS Fifty patients with 106 cysts were operated using the standardized technique comprising of liver mobilization, intraoperative ultrasound, systematic methylene blue injection to detect cystobiliary fistulas and omentoplasty. The median age of the patients was 44(semi-interquartile range: 16) years. The main symptom described by the patient was pain in 43 cases (86%). An abnormal liver test was found in 20 cases (40%). On imaging studies, the cyst had a median size of 7.4(3.0) cm. Cyst of the hepatic dome accounted for 38 cases (35.8%) with most cysts being situated in the right hemi-liver. Visual inspection of the cavity and Methylene blue testing allowed for the discovery of 57 cysts (53.7%) that had cystobiliary fistulas that were sutured. Omentoplasty was performed in 77 cysts (72.6%). Postoperatively, only 2 cases (1.9%) developed a DSSI in the form of an external bile leak with resolved with conservative management. No case of recurrence was found after a median follow-up of 24 months. CONCLUSION The standardized conservative surgical technique, in selected patients, shows promise in reducing DSSI rates and overall morbidity, and achieve as equally good result as radical management.
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Affiliation(s)
- Aymen Trigui
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Sami Fendri
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Mohammad Saad Saumtally
- University of Sfax, Faculty of Medicine; Department of Epidemiology. Hédi Chaker Hospital, Sfax, Tunisia
| | - Amira Akrout
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Jihen Trabelsi
- University of Sfax, Faculty of Medicine; Department of Epidemiology. Hédi Chaker Hospital, Sfax, Tunisia
| | - Rahma Daoud
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Nozha Toumi
- University of Sfax, Faculty of Medicine; Department of Radiology. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Salma Ketata
- University of Sfax, Faculty of Medicine; Department of Anaesthesiology. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Wael Boujelbene
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Rafik Mzali
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Chadli Dziri
- University of Tunis, General Surgery; Honoris Medical Simulation Centre director, Tunisia
| | - Mohamed Ben Amar
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Salah Boujelben
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
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Yilmaz L, Bulut A, Aytekin A, Baskonus I, Yildiz F, Coban S, Balik AA. A Novel Technique for the Management of Persistent Biliary Fistulas Developing After Liver Hydatid Cyst Surgeries: Drain Clamping Technique. Dig Dis Sci 2024; 69:961-968. [PMID: 38340259 DOI: 10.1007/s10620-024-08284-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 01/05/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND External biliary fistula, where the residual cyst is associated with the biliary tree, is one of the most common complications after liver hydatid cyst surgery. Surgical procedures become a consideration for patients in whom the biliary fistula persists despite all endoscopic procedures. However, reoperation for biliary fistula after hydatid cyst surgery leads to additional complications and increases morbidity and mortality. AIM This study aims to treat persistent biliary fistulas that develop after liver hydatid cyst surgery using a simple noninvasive technique. MATERIALS AND METHODS External drainage surgery was performed on 295 patients with liver hydatid cysts. Endoscopic treatment methods were used in patients who developed biliary fistula after surgery. Despite all endoscopic treatment methods, 14 patients developed persistent biliary fistulas. These patients were subsequently treated using the drain clamping technique. FINDINGS All persistent fistulas occluded in 11.86 days (with a range of 8-20 days). No complications were observed in the one-year follow-up visits. CONCLUSION Drain clamping, a novel approach to the treatment of persistent biliary fistulas developed despite all available endoscopic methods, can be safely used. This technique resulted in a complete recovery in patients without the need for surgical procedures.
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Affiliation(s)
- Latif Yilmaz
- Department of General Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Aziz Bulut
- Department of General Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Alper Aytekin
- Department of General Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ilyas Baskonus
- Department of General Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Fahrettin Yildiz
- Department of General Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Sacid Coban
- Department of General Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ahmet A Balik
- Department of General Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey
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Nayar R, Varshney VK, Hussain S, Yadav T, Puranik A. Left hepatectomy for hepatic hydatid cyst with intra-biliary rupture: Better to be radical. Med J Armed Forces India 2023; 79:S325-S328. [PMID: 38144643 PMCID: PMC10746817 DOI: 10.1016/j.mjafi.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Echinococcal liver cysts are predominantly located in the right lobe of the liver and are mostly asymptomatic. A frank intra-biliary rupture (IBR) of hydatid cyst is uncommon, having variable clinical presentation and treatment options. We present a case of a 60-year-old male patient who presented with pain in the upper abdomen associated with vomiting but without jaundice. On investigations, he was diagnosed to have a left lobe hepatic hydatid cyst (HHC) with IBR for which left hepatectomy with bile duct exploration was performed. It highlights the benign nature of the disease for which seldom major hepatectomies have to be performed.
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Affiliation(s)
- Raghav Nayar
- Senior Resident (Surgical Gastroenterology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vaibhav Kumar Varshney
- Associate Professor (Surgical Gastroenterology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sabir Hussain
- Associate Professor (Medical Gastroenterology), Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Associate Professor (Diagnostic & Interventional Radiology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ashok Puranik
- Professor (Surgical Gastroenterology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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12
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Habeeb TAAM, Podda M, Tadic B, Shelat VG, Tokat Y, Abo Alsaad MI, Kalmoush AE, Nassar MS, Mustafa FM, Morsi Badawy MH, Sobhy Shaaban M, Mohamed TZ, El Sayed Henish MI, Elbelkasi H, Abdou Yassin M, Mostafa A, Ibrahim A, A-Abdelhady W, Elshahidy TM, Mansour MI, Moursi AM, Abdallah Zaitoun M, Abd-Allah ES, Abdelmonem Elsayed A, S Elsayed R, M Yehia A, Abdelghani A, Negm M, Abo-Alella HA, Elaidy MM. Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study. World J Methodol 2023; 13:272-286. [PMID: 37771864 PMCID: PMC10523247 DOI: 10.5662/wjm.v13.i4.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study was to identify whether occult cysto-biliary communication (CBC) can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase (ALP) levels in predicting POBF and recurrent HCD. AIM To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD. METHODS From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence. RESULTS There was a highly statistically significant association (P ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association (P ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively. CONCLUSION Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.
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Affiliation(s)
- Tamer A A M Habeeb
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari 09126, Italy
| | - Boris Tadic
- Clinic for Digestive Surgery – First Surgical Clinic, University Clinical Centre of Serbia, Belgrade 11000, Serbia
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 018971, Singapore
| | - Yaman Tokat
- Department of Liver Transplantation and Hepatobiliary Surgery, Istanbul, Turkey, International Liver Center, and Acibadem Hospital Group, Istanbul 34000, Turkey
| | | | - Abd-Elfattah Kalmoush
- Department of General Surgery, Faculty of Medicine, Al-Azher University, Cairo 11765, Egypt
| | | | - Fawzy Metwally Mustafa
- Department of General Surgery, Faculty of Medicine, Al-Azher University, Cairo 11765, Egypt
| | | | - Mohamed Sobhy Shaaban
- Department of General Surgery, Faculty of Medicine, Al-Azher University, Cairo 11765, Egypt
| | - Tarek Zaghloul Mohamed
- Department of General Surgery, Faculty of Medicine, Al-Azher University, Cairo 11765, Egypt
| | | | - Hamdi Elbelkasi
- Department of General Surgery, Mataryia Teaching Hospital, Cairo 11765, Egypt
| | - Mahmoud Abdou Yassin
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Abdelshafy Mostafa
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Amr Ibrahim
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Waleed A-Abdelhady
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | | | | | - Adel Mahmoud Moursi
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | | | - Ehab Shehata Abd-Allah
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | | | - Rasha S Elsayed
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Ahmed M Yehia
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Amr Abdelghani
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Mohamed Negm
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | | | - Mostafa M Elaidy
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
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Comparison of ethanol and hypertonic saline as a single ıntracystic agent in the percutaneous treatment of liver hydatid cysts. Abdom Radiol (NY) 2023; 48:1148-1153. [PMID: 36627404 DOI: 10.1007/s00261-022-03795-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE In this study, the effects of hypertonic saline and ethanol as a single intracystic agents in the percutaneous treatment of liver hydatid cysts were compared. METHODS The 50 patients were separated into two groups as those administered 30% hypertonic saline alone as the intracystic agent in percutaneous treatment (33 patients, 52 cysts), and those administered 96% ethanol alone (17 patients, 26 cysts). Both groups were compared in terms of percentage of cyst volume reduction, complications, and treatment success. RESULTS The follow-up period was median 17.0 months (11.0-20.0) in the ethanol group and 17.0 (14.0-22.0) in the hypertonic saline group (p = 0.269). Complications were observed in 5 (19.2%) cysts applied with ethanol as the intracystic agent and in 7 (13.5%) of the cysts where hypertonic saline was used (p = 0.521). Clinical success was evaluated as 100% in both groups. The percentage of cyst volume reduction according to the initial volume was determined as mean 75.6 ± 20.43 (28.19-98.13) in the ethanol group cysts and as 68.2 ± 16.45 (26.39-97.48) in the hypertonic saline group (p = 0.427). CONCLUSION The results of this study demonstrated similar efficacy of hypertonic saline and ethanol in the percutaneous treatment of CE1 and CE3A liver hydatid cysts. These results suggest that the use of hypertonic saline as a single intracystic agent in the percutaneous treatment of CE1 and CE3A liver hydatid cysts provides sufficient efficacy of treatment and cyst volume reduction. Nevertheless, there is a need for further prospective, randomized studies to support these findings.
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14
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Ahire P, Iyer N, Gada PB. Complication of Hepatic Hydatid Cyst Surgery Presenting as Obstructive Jaundice. Cureus 2023; 15:e35410. [PMID: 36994267 PMCID: PMC10042515 DOI: 10.7759/cureus.35410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/31/2023] Open
Abstract
The liver is the commonest organ affected by hydatid disease. We report a rare case of a 25-year-old female patient who was treated surgically for hepatic echinococcosis two weeks ago with laparoscopic excision of hepatic hydatid cyst with marsupialization and omentoplasty. She then presented with features of obstructive jaundice, which is a known complication following hydatid endocystectomy. Cholangiogram revealed a communication of the residual hydatid cyst with right segmental intrahepatic biliary radicals. She was treated with endoscopic retrograde cholangiopancreatography (ERCP)-guided stenting. ERCP is regarded as an important therapeutic strategy for hydatid cysts occurring in the extra biliary tree either as primary or as complications of liver cysts. It facilitates the clearing of hydatid debris from the biliary tree, and the closure of fistulas and bile leaks followed by laparoscopic cholecystectomy when the hydatid cysts are also located in the gallbladder.
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Affiliation(s)
- Priya Ahire
- General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Nandhini Iyer
- General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Parth B Gada
- General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
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15
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Milky White Lipid Solution Injection Through Cystic Duct to Recognise Biliary Hydatid Fistula — an Innovative Technique. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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16
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DİZEN H, YALINBAŞ KAYA B. Surgical treatment of liver hydatic cyst and evaluation of cystobiliary fistula: experience of two centers. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1112941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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 (18-71), 68 of whom were men and 103 were women. Bile leakage was present in 50 patients (50 (29.23%)). There were 24 (48%) men and 26 (52%) women with bile leakage. The cyst diameter was 74.2 (36-170) mm and the number of cysts was 1.2 (1-2). The cysts were located in the right lobe of the liver in 116 (79%) patients, in the left lobe in 30 (15%) patients, and in both lobes in 25 (6%) patients. Cystobiliary fistula developed more frequently, especially in cysts located in the right lobe(36 (72%)). Cystobiliary fistula was most common in CE3 (Gharbi type 2) type (30 (60%)). Cystectomy+drainage was performed in 137 (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 (p<0.001). Aminotransferase (AST and ALT) levels were high in patients with cystobiliary fistula (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 (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 (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.
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Affiliation(s)
| | - Berrin YALINBAŞ KAYA
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ESKİŞEHİR ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
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17
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Öztürk G, Uzun MA, Özkan ÖF, Kayaalp C, Tatlı F, Eren S, Aksungur N, Çoker A, Bostancı EB, Öter V, Kaya E, Taşar P. Turkish HPB Surgery Association consensus report on hepatic cystic Echinococcosis (HCE). Turk J Surg 2022; 38:101-120. [PMID: 36483170 PMCID: PMC9714645 DOI: 10.47717/turkjsurg.2022.5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cystic Echinococcosis (CE) is one of the important problems of the Eurasian region. We aimed to prepare a consensus report in order to update the treatment approaches of this disease. This study was conducted by Turkish HPB Surgery Association. MATERIAL AND METHODS This study was conducted with the modified Delphi model. For this purpose, we conducted a three-stage consensus-building approach. RESULTS Six topics, including diagnosis, medical treatment, percutaneous treatment, surgical treatment, management of complications and posttreatment follow-up and recurrences in HCE were discussed. CONCLUSION The expert panel made recommendations for every topic.
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Affiliation(s)
- Gürkan Öztürk
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Mehmet Ali Uzun
- Clinic of General Surgery, Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Türkiye
| | - Ömer Faruk Özkan
- Clinic of General Surgery, Ümraniye Education and Research Hospital, İstanbul, Türkiye
| | - Cüneyt Kayaalp
- Department of General Surgery, Yeditepe University Faculty of Medicine, İstanbul, Türkiye
| | - Faik Tatlı
- Department of General Surgery, Harran University Faculty of Medicine, Şanlıurfa, Türkiye
| | - Suat Eren
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Nurhak Aksungur
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Ahmet Çoker
- Clinic of General Surgery, Medicana International İzmir Hospital, İzmir, Türkiye
| | | | - Volkan Öter
- Clinic of Gastroenterological Surgery, Ankara State Hospital, Ankara, Türkiye
| | - Ekrem Kaya
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Pınar Taşar
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
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Leeuw D, van der Schaar PJ, Zoutendijk R. Biliary obstruction caused by an erupted hepatic hydatid cyst. Endoscopy 2022; 54:E98-E99. [PMID: 33784752 DOI: 10.1055/a-1388-5323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Dianne Leeuw
- St. Antonius Hospital, Department of Gastroenterology, Nieuwegein, The Netherlands
| | | | - Roeland Zoutendijk
- St. Antonius Hospital, Department of Gastroenterology, Nieuwegein, The Netherlands
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Abstract
OBJECTIVE We aimed to determine the effective factors in the selection of treatment methods for patients with hepatic hydatid cyst undergoing surgery and the variables effective when performing postoperative endoscopic retrograde cholangiopancreatography (ERCP). In addition, we aimed to reveal the factors affecting the recurrence, postoperative complications, and length of stay of these patients. MATERIALS AND METHODS A total of 107 patients diagnosed with hepatic hydatid cysts were treated surgically. Data were obtained from the records of these patients. Chi-square test was used for the analysis. The variables that were found to be significant in the chi-square analysis were included in the logistic regression (Backward: LR) analysis. RESULTS Of all patients, 6.5% underwent the puncture, aspiration, injection, and reaspiration (PAIR) technique, 67.3% underwent conservative surgery, and 26.2% underwent radical surgical treatment. In paired comparisons, a significant difference was found among the ultrasonographic size of the cyst (p = 0.033), the radiological classification of the cyst (0.006), and history of previous surgery and treatment methods for the cyst. The risk of performing ERCP was 25.710 [95% confidence interval (CI): 1.721-284.013] folds higher for cysts located in the left lobe, whereas it was 19.992 (95% CI: 2.004-199.488) folds higher for cysts located in both right and left lobes. When the radical surgical treatment method was taken as a reference, the status of ERCP implementation was 29.785 (95% CI: 1.844-480.996) folds higher for PAIR and 3.628 (95% CI: 0.355-37.103) folds higher for conservative surgery. CONCLUSION In conclusion, radical surgery is a significant treatment for hepatic hydatid cyst as its ultrasonographic cyst size increases with time. The location and treatment method of the cyst increases the complication of biliary fistula and requires ERCP.
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Affiliation(s)
- Hasan Cantay
- Department of General Surgery, Kafkas University School of Medicine, Kars, Turkey
| | - Turgut Anuk
- Department of General Surgery, Kafkas University School of Medicine, Kars, Turkey
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20
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Jaén-Torrejimeno I, Latorre-Fragua R, López-Guerra D, Rojas-Holguín A, Manuel-Vázquez A, Blanco-Fernández G, Ramia JM. Jaundice as a clinical presentation in liver hydatidosis increases the risk of postoperative biliary fistula. Langenbecks Arch Surg 2021; 406:1139-1147. [PMID: 33389115 DOI: 10.1007/s00423-020-02070-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Echinococcosis, also known as hydatidosis, is a zoonosis that is endemic in many countries worldwide. Liver hydatid cysts have a wide variety of clinical manifestations, among which obstructive jaundice is one of the rarer forms. The aims of the study were to analyze the preoperative management of these patients and to record the kind of surgical treatment performed and the short- and long-term postoperative results. METHODS A retrospective two-center observational study of patients operated upon for liver hydatidosis with initial symptoms of obstructive jaundice. Preoperative characteristics, surgical data, and postoperative complications, including biliary fistula, were recorded. RESULTS Of 353 patients operated upon for liver hydatidosis, 44 were included in the study. Thirty-five patients (79.6%) were defined as CE2 or CE3 in the World Health Organization (WHO) classification. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 25 patients (56.8%) and identified intrabiliary communication in 29. Radical surgery was carried out in 29 of the total sample (65.9%). Severe postoperative complications (Clavien-Dindo grade IIIA or higher) were recorded in 25% of patients. The factors associated with greater postoperative morbidity were age above 65 (HR 8.76 [95% CI 0.78-97.85]), cyst location (HR 4.77 [95% CI 0.93-24.42]), multiple cysts (HR 14.58 [95% CI 1.42-149.96]), and cyst size greater than 5 cm (HR 6.88 [95% CI 0.95-50]). CONCLUSION The presentation as obstructive jaundice causes greater postoperative morbidity. The main postoperative complication in these cases, despite radical surgery, is biliary fistula. In our series, routine preoperative ERCP did not show any benefit.
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Affiliation(s)
- Isabel Jaén-Torrejimeno
- Department of HBP and Liver Transplant Surgery, University Hospital Complex Badajoz, University of Extremadura, Avda de Elvas s/n, 06080, Badajoz, Spain
| | - Raquel Latorre-Fragua
- Department of HBP, General and Digestive Surgery, University Hospital of Guadalajara, Guadalajara, Spain
| | - Diego López-Guerra
- Department of HBP and Liver Transplant Surgery, University Hospital Complex Badajoz, University of Extremadura, Avda de Elvas s/n, 06080, Badajoz, Spain
| | - Adela Rojas-Holguín
- Department of HBP and Liver Transplant Surgery, University Hospital Complex Badajoz, University of Extremadura, Avda de Elvas s/n, 06080, Badajoz, Spain
| | - Alba Manuel-Vázquez
- Department of HBP, General and Digestive Surgery, University Hospital of Guadalajara, Guadalajara, Spain
| | - Gerardo Blanco-Fernández
- Department of HBP and Liver Transplant Surgery, University Hospital Complex Badajoz, University of Extremadura, Avda de Elvas s/n, 06080, Badajoz, Spain.
| | - José Manuel Ramia
- Department of HBP, General and Digestive Surgery, University Hospital of Alicante, Alicante, Spain
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Uylas U, Tardu A, Kayaalp C. Bile leakage test in emergency hydatid liver cyst surgery. Int J Surg Case Rep 2021; 79:459-461. [PMID: 33757262 PMCID: PMC7851330 DOI: 10.1016/j.ijscr.2021.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/09/2021] [Accepted: 01/09/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE In liver cyst hydatid surgery, presence of cysto-biliary communication (CBC) is important for the prevention of postoperative morbidity. If cysto-biliary connections are not obvious, diagnosis is not easy. Intraoperative bile leakage test has been shown to reduce postoperative biliary complications by revealing occult CBCs. However, bile leakage testing in emergency conditions such as hydatid cyst perforation has not been experienced so far. CASE PRESENTATION Here, a bile leakage test performed in a 23-year-old male patient undergoing emergency surgery due to the perforation of the hydatid liver cyst was presented. Following the treatment of perforated hydatid liver cyst and biliary peritonitis, a bile leakage test was performed. The common bile duct was cannulated with a 22G catheter, normal saline and parenteral lipid solution were given to demonstrate the CBCs, and leakage areas were suture ligated. The patient was discharged postoperatively without any problem. CONCLUSION We recommend detection and treatment of the CBCs even in emergency hydatid liver cyst surgery for prevention of postoperative biliary complications.
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Affiliation(s)
- Ufuk Uylas
- İzmir SBÜ Tepecik Training and Research Hospital, General Surgery Department, İzmir, Turkey.
| | - Ali Tardu
- Bursa Yüksek İhtisas Training and Research Hospital, Department of Gastrointestinal Surgery, Bursa, Turkey.
| | - Cuneyt Kayaalp
- Yeditepe University Faculty of Medicine, Department of Gastrointestinal Surgery, İstanbul, Turkey.
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Ben Mahmoud A, Atri S, Rebai W, Maghrebi H, Makni A, Kacem MJ. Acute pancreatitis as an uncommon complication of hydatid cyst of the liver: A case report and systematic literature review. Ann Med Surg (Lond) 2021; 62:341-346. [PMID: 33552493 PMCID: PMC7847814 DOI: 10.1016/j.amsu.2021.01.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/21/2022] Open
Abstract
Hydatid disease is a major health problem worldwide. The liver is the most frequent location of hydatid disease. Acute pancreatitis secondary to liver hydatid cyst ruptured in the biliary tract is scarce and fewly described in literature. The management of this pancreatic complication of liver hydatid disease is challenging and includes a combination of surgical and endoscopic approaches. We report herein a rare case of hydatid cyst of the liver with cysto-biliary communication revealed by acute pancreatitis. A systematic literature review of similar cases reported was provided to compare surgical and endoscopic techniques. A thirty-year-old woman was referred to our emergency unit for acute pancreatitis. The CT-scan findings revealed a liver hydatid cyst ruptured in the biliary tract and daughter vesicles within were found, responsible for C-grade acute pancreatitis. We decided then to perform an emergency surgery through a bisoucostal incision. We performed a cholecystectomy and a peroperative cholangiogram that showed the communication between the cyst and left biliary tracts and the presence of daughter vesicle within the common bile duct. We conducted an exploration of the common bile duct with extraction of vesicle daughters. We left behind a T-tube in the common bile duct and we sutured the cysto-biliary fistula. Drainage was left in the remnant cavity after unroofing the cyst. Postoperative course was uneventful. Six months follow-up showed no recurrence. Cysto-biliary communication of liver hydatid disease revealed by acute pancreatitis is uncommon. We chose to perform emergency open surgery. However, through a systematic literature review, we noticed that endoscopic treatment is an efficient therapeutic and diagnostic tool to delay a morbid surgery of the liver and the common bile duct.
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Affiliation(s)
- Ahmed Ben Mahmoud
- Department of Surgery “A”, La Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis El Manar University, Tunis, Tunisia
| | - Souhaib Atri
- Department of Surgery “A”, La Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis El Manar University, Tunis, Tunisia
| | - Wael Rebai
- Department of Surgery “A”, La Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis El Manar University, Tunis, Tunisia
| | - Houcine Maghrebi
- Department of Surgery “A”, La Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis El Manar University, Tunis, Tunisia
| | - Amine Makni
- Department of Surgery “A”, La Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis El Manar University, Tunis, Tunisia
| | - Montasser Jameleddine Kacem
- Department of Surgery “A”, La Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunisia, Tunis El Manar University, Tunis, Tunisia
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Fancellu A, Perra T, Vergari D, Vargiu I, Feo CF, Cossu ML, Deiana G, Porcu A. Management of complex liver cystic hydatidosis: challenging benign diseases for the hepatic surgeon: A case series report from an endemic area. Medicine (Baltimore) 2020; 99:e23435. [PMID: 33235127 PMCID: PMC7710265 DOI: 10.1097/md.0000000000023435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/03/2020] [Accepted: 10/25/2020] [Indexed: 02/05/2023] Open
Abstract
Hydatid cysts of the liver are benign lesions which require a wide range of surgical strategies for their treatment. We hypothesized that cysts larger than 15 cm, or compressing main vascular structures, or located in both hemilivers should be considered, as well as complicated cysts, in the category of complex hydatid cysts.In a retrospective study including 55 patients, we evaluated the characteristics of complex hydatid cysts, and compared surgical outcomes between patients operated on for complex cysts (Complex Group) and those operated on for non-complex cysts (non-Complex Group).In the Complex Group, 19% of patients had cysto-biliary communication with recurrent cholangitis, 9.5% had cysts eroding the diaphragm or chest wall, or communicating with the bronchial tree, 31% had cysts with contact with main vascular structures, 11.9% had multiple bilobar cysts, 14.3% had giant cysts with organ displacement, and 14.3% had a combination of the above-mentioned types. Type of surgical treatment was different between the two groups (P < .001). Additional procedures were statistically more frequent in the Complex Group (P = .02). Postoperative morbidity was higher in the Complex Group, although not in a significant manner (P = .07). Median hospital stay was longer in the Complex Group (12 vs 7 days, P < .001). No 30-day mortality occurred. Four patients (7.3%), all belonging to the Complex Group, required reoperation for postoperative complications.Surgery for complex hydatid cysts of the liver is potentially burdened by serious complications. This kind of benign liver disease requires skill-demanding procedures and should be treated in centers with expertise in both hepato-biliary surgery and hydatid disease management.
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Saldaña C, Bolado F, González de la Higuera B, Borobio E, Casi MA. Biliary stenosis secondary to fistulised hydatid cyst that mimics Klatskin tumour. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:455-456. [PMID: 32444237 DOI: 10.1016/j.gastrohep.2020.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/14/2019] [Accepted: 01/23/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Cristina Saldaña
- Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - Federico Bolado
- Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | | - Erika Borobio
- Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Maria Angeles Casi
- Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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Surgical management of hepatic hydatid cysts - conservative versus radical surgery. HPB (Oxford) 2020; 22:1457-1462. [PMID: 32229090 DOI: 10.1016/j.hpb.2020.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/10/2020] [Accepted: 03/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgical management is considered one of the effective treatment modality for liver hydatid. However the choice of surgery is debatable. This study aims to compare the outcome of radical surgery (RS) and conservative surgery (CS) in liver hydatid disease. METHODS This is retrospective analysis of prospectively maintained institutional data of surgically treated liver hydatid from January 2012 to January 2019. The basis of diagnosis was typical imaging, confirmatory Hydatid serology and/or Intraoperative details. The clinical presentation, radiological data, operative detail, post-operative outcome, post-operative recurrence data was analysed. RESULTS Sixty-four patients underwent surgery during the study period and were included. RS was done in 27 (42.2%) patients and CS in 37 (57.8%) patients. The mean age was 35.6 (13-72) years. The mean size of the cyst was 10.3 ± 2.9 cm. The cyst location was peripheral in 81.5% and 56.8% in RS and CS groups respectively. Intraoperative Cyst biliary communication was detected in 48.1% of RS & 35.1% in CS group of patients. The post-operative bile leak was significantly less in RS group (7.4% vs 27.0%, p = 0.047). Postoperative endoscopic stenting for persistent biliary fistula was necessitated in five of CS and only one patient from RS group. None of RS patients had recurrence while 3 patients of CS developed recurrence. CONCLUSION Radical surgery reduces post-operative bile leak and prevents recurrence and may be preferable to conservative surgery.
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Treatment of Hepatic Hydatid Disease: Role of Surgery, ERCP, and Percutaneous Drainage: A Retrospective Study. Surg Laparosc Endosc Percutan Tech 2020; 31:313-320. [PMID: 32956333 DOI: 10.1097/sle.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/14/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Failure to follow the World Health Organization's Informal Working Group on Echinococcosis guidance or having limited experience in the management of cystic echinococcosis (CE) in endemic or nonendemic areas of the world may lead to risky unnecessary procedures. MATERIALS AND METHODS Medical records of all patients undergoing surgery for hepatic hydatid disease at the gastroenterologic surgery and general surgery departments of our hospital between December 2014 and October 2019 were collected and reviewed retrospectively. Demographic characteristics, the size and number of the cysts preoperative liver function tests, surgical treatment, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage (PD), morbidity, and treatment outcomes were reviewed. RESULTS Of 122 patients included in the study, 77 (63, 1%) were female and 45 (36, 9%) were male individuals and their mean age was 44.95 years. CE1 was identified in 13 patients (10.6%) CE2 in 66 patients (54.1%), CE3a in 7 patients (5.8%), CE3b in 28 patients (22.9%), and CE4 in 8 patients (6.6%). Twenty patients (16.4%) with a cystobiliary fistula in the liver, obstructive jaundice, and postoperative bile leak underwent ERCP. PD was performed in patients with fluid in the hepatic hydatid cyst pouch, increased pouch size because of bile collection, and clinical symptoms postoperatively. Patients presenting with persistent bile leak despite PD underwent ERCP and were treated with endoscopic sphincterotomy and stent placement. Patients with PD were followed by keeping the percutaneous drain open and closed for a while to create pressure difference in the cyst pouch after ERCP. The percutaneous drain was removed in the next 14 to 21 days after checking the pouch size, whereas the common bile duct stents were removed 2 months later after performing a follow-up cholangiography. CONCLUSIONS ERCP should be the primary method for the diagnosis and treatment for hepatic hydatid cysts ruptured into the ducts. İn some cases, high-flow hydatid cysts with rupture into the bile ducts or persistent biliary fistulas can be treated with ERCP and endoscopic sphincterotomy, biliary stent, PD, and nasobiliary drainage without the need for surgical intervention.
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Ramia Ángel JM, Manuel Vázquez A, Gijón Román C, Latorre Fragua R, de la Plaza Llamas R. Radical surgery in hepatic hydatidosis: analysis of results in an endemic area. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:708-711. [PMID: 32496115 DOI: 10.17235/reed.2020.6722/2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION radical surgery in hepatic hydatidosis is associated with less morbidity and recurrence than conservative surgery. MATERIAL AND METHODS a retrospective observational study of patients with liver hydatid cyst surgery was performed. Seventy-one patients with 90 cysts were included between 2007 and 2017, and radical surgery was performed in 69.01 %. RESULTS there was no difference in morbidity, mortality, biliary leakage or recurrence according to surgery. Complicated cysts were associated with a longer hospital stay and morbidity. CONCLUSION decision-making should consider age, comorbidity, cyst characteristics and available resources. Radical surgery should be applied whenever feasible as it achieves better results with an adequate selection of patients.
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Nomogram Analysis and Internal Validation to Predict the Risk of Cystobiliary Communication in Patients Undergoing Hydatid Liver Cyst Surgery. World J Surg 2020; 44:3884-3892. [PMID: 32647987 PMCID: PMC7527320 DOI: 10.1007/s00268-020-05661-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose Biliary leakage caused by cystobiliary communication (CBC) is a common clinical concern. This study sought to identify predictors of CBC in hepatic cystic echinococcosis (HCE) patients undergoing hydatid liver cyst surgery and establish nomograms to predict CBC. Methods A predictive model was established in a training cohort of 310 HCE patients diagnosed between January 2013 and May 2017. Upon revision of the records of clinical parameters and imaging features of these patients, the lasso regression model was used to optimize feature selection for the CBC risk model. Combined with feature selection, a CBC nomogram was developed with multivariable logistic regression. C-index and calibration plots were used to analyze and evaluate the discrimination and calibration. The net benefit and predictive accuracy of the nomogram were performed via decision curve analysis (DCA) and receiver operating characteristic (ROC) curve. An independent validation cohort of 132 patients recruited from June 2017 to May 2019 was used to evaluate the practicability of the nomogram. Results Predictors contained four features, namely alkaline phosphatase (ALP), glutamyl transpeptidase (GGT), cyst size and cyst location. The C-index of the nomogram is 0.791 (95% CI, 0.736–0.845), while the C-index verified by bootstrap is 0.746, indicating high prediction accuracy. The area under the curve (AUC) of the CBC in training was 0.766. ROC curve analysis demonstrated high sensitivity and specificity. Decision curve analysis confirmed the CBC nomogram was clinically useful when the intervention was determined at the non-adherence possibility threshold of 8%. Conclusion The nomogram developed using the ALP, GGT, cyst size and cyst location could be used to facilitate the CBC risk prediction in HCE patients.
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Pattern of Relapse in Hepatic Hydatidosis: Analysis of 238 Cases in a Single Hospital. J Gastrointest Surg 2020; 24:361-367. [PMID: 30809783 DOI: 10.1007/s11605-019-04163-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/06/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hydatidosis is a chronic disease that is endemic and prevalent in certain regions of the world. Surgical treatment is the best option, although its main problem is that there is a high rate of recurrence. The objective of the present study was to assess its therapeutic management and the factors related to its postoperative morbidity and relapse. MATERIAL AND METHODS A descriptive and retrospective study was made of 238 patients with hepatic hydatidosis operated from January 2006 to December 2017 at our center. An analysis was made of the variables associated with postoperative morbidity and relapse, and of the temporal pattern of that relapse. RESULTS Out of 238 patients, radical surgery was performed in 132 (55.5%) and partial cystectomy in 106 of them (44.3%). The postoperative morbidity was 42% (100/238) and the relapse rate was 7.2% (17/238). The factors associated with greater postoperative morbidity were partial cystectomy (OR, 2.83 (1.47-5.43); p = 0.002), ≥ 2 cysts (OR, 3.22 (1.51-6.86); p = 0.002), and biliary fistula (OR, 4.34 (2.11-8.91); p < 0.0001); and those associated with higher relapse rate were history of hydatidosis (OR, 4.98 (1.76-14.11); p = 0.003) and ≥ 2 cysts (OR, 3.23 (1.14-9.11); p = 0.027). The first relapses appeared after 14 months, with the greatest incidence between 14 and 36 months. CONCLUSIONS The surgical procedure applied is associated with morbidity but not with that of relapse. The observed relapse pattern demonstrates the need to maintain long-term follow-up, but with no follow-up being necessary in the first year. Broader multicenter and prospective studies are needed to establish more precise recommendations.
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Dulundu E. Management of Hepatic Echinococcal Disease and Its Complications. THE SURGICAL MANAGEMENT OF PARASITIC DISEASES 2020:129-141. [DOI: 10.1007/978-3-030-47948-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Porcu A, Fancellu A, Cherchi G, Nigri G. The Role of Emergency Surgery in Hydatid Liver Disease. THE SURGICAL MANAGEMENT OF PARASITIC DISEASES 2020:199-207. [DOI: 10.1007/978-3-030-47948-0_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Naar L, Hatzaras I, Arkadopoulos N. Management of Cystic Echinococcosis Complications and Dissemination. THE SURGICAL MANAGEMENT OF PARASITIC DISEASES 2020:209-228. [DOI: 10.1007/978-3-030-47948-0_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Complications of hepatic echinococcosis: multimodality imaging approach. Insights Imaging 2019; 10:113. [PMID: 31792750 PMCID: PMC6889260 DOI: 10.1186/s13244-019-0805-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023] Open
Abstract
Hydatid disease is a worldwide zoonosis endemic in many countries. Liver echinococcosis accounts for 60-75% of cases and may be responsible for a wide spectrum of complications in about one third of patients. Some of these complications are potentially life-threatening and require prompt diagnosis and urgent intervention. In this article, we present our experience with common and uncommon complications of hepatic hydatid cysts which include rupture, bacterial superinfection, and mass effect-related complications. Specifically, the aim of this review is to provide key imaging features and diagnostic clues to guide the imaging diagnosis using a multimodality imaging approach, including ultrasound (US), computed tomography (CT), magnetic resonance (MR), and endoscopic retrograde cholangiopancreatography (ERCP).
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Should Pediatricians Be Aware of Cystic Echinococcosis? A Literature Review. J Pediatr Gastroenterol Nutr 2019; 69:e120. [PMID: 31348123 DOI: 10.1097/mpg.0000000000002452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Thomas MN, Zwingelberg S, Angele M, Guba M, Werner J. [Diagnosis and treatment of cystic and alveolar echinococcosis]. MMW Fortschr Med 2019; 159:38-42. [PMID: 28924720 DOI: 10.1007/s15006-017-9948-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Michael N Thomas
- Klinikum der Universität München, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Marchioninistraße 15, D-81377, München, Deutschland.
| | - S Zwingelberg
- Klinikum der Universität München, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Marchioninistraße 15, D-81377, München, Deutschland
| | - Martin Angele
- Klinikum der Universität München, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Marchioninistraße 15, D-81377, München, Deutschland
| | - Markus Guba
- Klinikum der Universität München, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Marchioninistraße 15, D-81377, München, Deutschland
| | - Jens Werner
- Klinikum der Universität München, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Marchioninistraße 15, D-81377, München, Deutschland
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Bayrak M, Altıntas Y. Current approaches in the surgical treatment of liver hydatid disease: single center experience. BMC Surg 2019; 19:95. [PMID: 31315619 PMCID: PMC6637587 DOI: 10.1186/s12893-019-0553-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
Background Liver hydatid disease is a common benign condition in many countries. Compared to open surgery, laparoscopic treatment can play an important role in improving the post-operative recovery, reducing the morbidity and recurrence rate of these patients.The purpose of this study is to show that the laparoscopic method is effective and safe in the treatment of liver hydatid cysts compared to open surgery, even in large cysts. Methods All consecutive cases surgically managed for liver hydatid cyst from 7 January 2008 and 15 January 2010 in our institution were included in this study.The surgical approach (laparoscopic or open) and operative strategy, as well as operative and prognostic outcomes, were analyzed. Cyst size, type, location, presence of biliary tract communication, radiological findings, duration of hospitalization, recurrence and postoperative morbidity were analysed and compared retrospectively. Results A total of 60 patients were included in the study.A total of 23 patients underwent open surgery, and 37 patients underwent laparoscopic surgery.Operation types of laparoscopic surgery were as follows: partial pericystectomy (12patients), total cystectomy(2 patients), partial pericystectomy+total cystectomy(7patients) and cystectomy(16patients).The surgical procedures chosen for open treatment of the residual cavity were partial pericystectomy and omentoplasty(17cases), total pericystectomy(3cases) and partial and total pericystectomy(3cases).Cysto-biliary communication was found in 9 patients. A total of 10 patients underwent preoperative endoscopic retrograde cholangiography, and one patient underwent postoperative endoscopic retrograde cholangiography.There was a progression of hypernatremia in 1 patient, wound infections in 3 patients, and perioperative hemorrhage in 3 patients. There were no statistically significant differences concerning age(p = 0.344), gender(p = 0.318), ASA classification(p = 0.963), Gharbi classification(p = 0.649) whereas there were significant differences related to cyst location(p = 0.040) and size(p = 0.022) in patients undergoing laparoscopic and open surgery. Postoperative temporary biliary fistulas were observed in 2 patients undergoing open surgery. Patients undergoing laparoscopic surgery had the advantages of shorter hospital stays and operation times, less blood loss, faster recovery, and lower wound infection rates. Recurrences were detected in 2.7% of patients undergoing laparoscopic surgery and 4.7% of those undergoing open procedures. Conclusion Compared to open surgery in the treatment of liver hydatid cysts, we have shown that laparoscopic method can be safely performed even in large cysts and/or cysto-biliary communication.
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Affiliation(s)
- Mehmet Bayrak
- Department of General Surgery , Ozel Ortadogu Hospital, Ziyapasa Mahallesi 67055 Sokak no:1, Adana, Turkey.
| | - Yasemin Altıntas
- Department of Radiology , Ozel Ortadogu Hospital, 01360, Adana, Turkey
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Toumi O, Ammar H, Gupta R, Ben Jabra S, Hamida B, Noomen F, Zouari K, Golli M. Management of liver hydatid cyst with cystobiliary communication and acute cholangitis: a 27-year experience. Eur J Trauma Emerg Surg 2018; 45:1115-1119. [PMID: 30191292 DOI: 10.1007/s00068-018-0995-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 08/20/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The rupture of the hydatid cyst into the bile ducts is a common and serious complication. The rupture can be latent or revealed after a complication such as acute cholangitis. The objective of this study was to discuss the clinical features, radiographic findings, and surgical treatment of this rare complication. METHODS A retrospective analysis of patients operated for acute cholangitis caused by hydatid cyst between January 1990 and May 2016 was conducted. RESULTS Our study included 55 cases of acute cholangitis caused by ruptured hydatid cyst: 35 were men and 20 were women. Five patients had medical history of hydatid cyst. On imaging, all patients had a dilated bile duct. In 51 cases, there was a single hydatid cyst. Hydatid cysts with fistula were located in the right lobe of the liver in 49 cases and in the left lobe in 6 cases. Seven patients underwent an emergency surgery after admission, while others were operated after 3-8 days. A conservative procedure associated with drainage was applied in 49 cases. Endoscopic treatment was performed in four cases which failed in two cases. Twenty-eight cases developed postoperative complications, among which the most common complication was biliary fistula (n - 17). There were eight cases of postoperative deaths (14.5%). CONCLUSIONS Liver hydatid cyst with cystobiliary communication and superadded acute cholangitis is a serious clinical problem requiring the early diagnosis and surgery in the absence of endoscopic therapy.
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Affiliation(s)
- Omar Toumi
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia.
| | - Houssem Ammar
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Sciences, Synergy Institute of Medical Sciences, Dehradun, India
| | - Sadok Ben Jabra
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Badii Hamida
- Department of Radiology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Khadija Zouari
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mondher Golli
- Department of Radiology, Fattouma Bourguiba Hospital, Monastir, Tunisia
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El-Gendi AM, El-Shafei M, Bedewy E. The Role of Prophylactic Endoscopic Sphincterotomy for Prevention of Postoperative Bile Leak in Hydatid Liver Disease: A Randomized Controlled Study. J Laparoendosc Adv Surg Tech A 2018; 28:990-996. [PMID: 29641366 DOI: 10.1089/lap.2017.0674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Bile leak is the main cause of morbidity and mortality after surgery for hydatid liver cysts. Aim was to assess the role of prophylactic endoscopic sphincterotomy (ES) in reducing postoperative bile leak in patients undergoing partial cystectomy. METHODS Fifty-four patients with hepatic hydatid cyst met inclusion criteria, 27 were excluded or declined to participate. Twenty-six women and 28 men (mean age 44.6 ± 10.1, range: 22-61 years) were randomly assigned to either group I with ES (n = 27) or group II without ES (n = 27). RESULTS Demographics and clinical, laboratory, and radiological characteristics of cysts were not statistically different between two groups. Group I had a significant decrease in bile leak rate compared with group II (11.1% versus 40.7%, P = .013), with significantly shorter duration of hospital stay (P < .0001). Biliary fistula in group I had significantly lower daily output (100 mL/day versus 350 mL/day) with gradual reduction till stoppage of leak in 3-4 days without intervention. Biliary fistula in group II had a significantly higher need for biliary intervention through postoperative endoscopic retrograde cholangiopancreatography with ES compared with biliary fistula in group I (FEP = .002), with significantly longer mean time of fistula closure (P = .011) and longer time to drain removal (P < .0001). Nonbiliary complications were comparable between two groups. CONCLUSION Prophylactic ES provides significant reduction in postoperative bile leak rate with shorter hospital stay after partial cystectomy of hydatid cyst. Biliary fistula in patients with ES has significantly lower daily output with shorter time of drain removal and shorter time to closure than patients without ES.
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Affiliation(s)
- Ahmed M El-Gendi
- 1 Department of Surgery, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mohamed El-Shafei
- 2 Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Essam Bedewy
- 3 Department of Hepatology and Tropical Medicine, Faculty of Medicine, Alexandria University , Alexandria, Egypt
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Akkapulu N, Aytac HO, Arer IM, Kus M, Yabanoglu H. Incidence and risk factors of biliary fistulation from a hepatic hydatid cyst in clinically asymptomatic patients. Trop Doct 2017; 48:20-24. [PMID: 28662605 DOI: 10.1177/0049475517717177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Biliary fistulation from a hepatic hydatid cyst is its most frequent complication. If unrecognised, this may cause difficulties during and after surgical intervention. Our study looked into its incidence and also the possible risk factors in a retrospective investigation of 60 patients (34 women) who had undergone surgery or percutaneous treatment. Demographics and anatomical characteristics, such as cyst type, location, number, diameter and laboratory findings were examined. A full 50% had biliary fistulation, with increased risk if the cyst diameter was ≥8.8 cm.
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Affiliation(s)
- Nezih Akkapulu
- 1 MD, FACS, Department of General Surgery, Adana Research and Teaching Centre, Baskent University, Adana, Turkey
| | - H Ozgur Aytac
- 2 MD, Department of General Surgery, Adana Research and Teaching Centre, Baskent University, Adana, Turkey
| | - Ilker M Arer
- 2 MD, Department of General Surgery, Adana Research and Teaching Centre, Baskent University, Adana, Turkey
| | - Murat Kus
- 2 MD, Department of General Surgery, Adana Research and Teaching Centre, Baskent University, Adana, Turkey
| | - Hakan Yabanoglu
- 2 MD, Department of General Surgery, Adana Research and Teaching Centre, Baskent University, Adana, Turkey
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Daldoul S, El Kebir GH, Messoudi I, Mabrouk A, Tahar Bouzidi M, Ben Moussa M. [Trans-hepatico cystic coledochostomy for the opening hydatid cyst in the biliary tract: Indications and outcome evaluation of 25 cases]. ACTA ACUST UNITED AC 2017; 110:180-190. [PMID: 28429278 DOI: 10.1007/s13149-017-0558-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 01/24/2017] [Indexed: 01/23/2023]
Abstract
The treatment of hydatid cysts of the liver opened in the bile ducts is sometimes difficult and complex. The trans-hepaticocystic coledochostomy (CTHK) is one of these processes. We conducted a review of the indications for this surgical procedure and its perioperative outcomes through a series of 25 patients and then we analyzed predictor factors of complications. During the period's study, 909 patients with liver hydatid cyst went under the surgery. Ninety two (92, i.e. 10.1%) of them had an opening in the bile ducts through a large fistula. Twenty five (25, i.e. 27%) had a trans-hepaticocystic coledochostomy. The sex ratio was 0.6. The population was young with an average age of 47 years. The trans-hepaticocystic coledochostomy was performed because of a thick pericyst associated with a nonsutured fistula in 18 cases, a voluminous residual cavity with a soft pericyst but the fistula was unexposed in six cases and in a case where the pericyst was thick, fistula was exposed. Its suture was associated with a high risk of bile duct stenosis. Specific morbidity was 20% due to a length of the intraductal coledochostomy under 2 cm (P = 0.016), the absence of an epiploplasty (P = 0.004) and the existence of a leak of contrast material outside the fistula on the cholangiography (P = 0.005). The trans-hepaticocystic coledochostomy is a safe and reliable technique, often indicated when other conservative methods are failing. The application of its technical requirements and avoidance of mounting errors allow reducing its morbidity.
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Affiliation(s)
- S Daldoul
- Service de chirurgie générale A, hôpital Charles-Nicolle, bld 9-Avril-1938, 1006, Tunis, Tunisie. .,Université Tunis El Manar, campus universitaire Farhat-Hached, BP no°94, Rommana, 1068, Tunis, Tunisie. .,Faculté de médecine de Tunis, rue de la Faculté-de-médecine, Tunis, Tunisie.
| | - G H El Kebir
- Service de chirurgie générale A, hôpital Charles-Nicolle, bld 9-Avril-1938, 1006, Tunis, Tunisie.,Université Tunis El Manar, campus universitaire Farhat-Hached, BP no°94, Rommana, 1068, Tunis, Tunisie.,Faculté de médecine de Tunis, rue de la Faculté-de-médecine, Tunis, Tunisie
| | - I Messoudi
- Service de chirurgie générale A, hôpital Charles-Nicolle, bld 9-Avril-1938, 1006, Tunis, Tunisie.,Université Tunis El Manar, campus universitaire Farhat-Hached, BP no°94, Rommana, 1068, Tunis, Tunisie.,Faculté de médecine de Tunis, rue de la Faculté-de-médecine, Tunis, Tunisie
| | - A Mabrouk
- Service de chirurgie générale A, hôpital Charles-Nicolle, bld 9-Avril-1938, 1006, Tunis, Tunisie.,Université Tunis El Manar, campus universitaire Farhat-Hached, BP no°94, Rommana, 1068, Tunis, Tunisie.,Faculté de médecine de Tunis, rue de la Faculté-de-médecine, Tunis, Tunisie
| | - M Tahar Bouzidi
- Service de chirurgie générale A, hôpital Charles-Nicolle, bld 9-Avril-1938, 1006, Tunis, Tunisie.,Université Tunis El Manar, campus universitaire Farhat-Hached, BP no°94, Rommana, 1068, Tunis, Tunisie.,Faculté de médecine de Tunis, rue de la Faculté-de-médecine, Tunis, Tunisie
| | - M Ben Moussa
- Service de chirurgie générale A, hôpital Charles-Nicolle, bld 9-Avril-1938, 1006, Tunis, Tunisie.,Université Tunis El Manar, campus universitaire Farhat-Hached, BP no°94, Rommana, 1068, Tunis, Tunisie.,Faculté de médecine de Tunis, rue de la Faculté-de-médecine, Tunis, Tunisie
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Patrono D, Tandoi F, Rizza G, Catalano G, Mirabella S, Celoria P, Corcione S, De Rosa FG, Salizzoni M, Romagnoli R. Liver transplantation with an uncommon full right hemiliver graft after hydatid cysts resection: Case report and review of the literature. Transpl Infect Dis 2017; 19. [PMID: 28244199 DOI: 10.1111/tid.12685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/23/2016] [Accepted: 12/04/2016] [Indexed: 11/28/2022]
Abstract
Because of widespread organ shortage, the transplant community has been exploiting more and more so-called "extended criteria" donors. In this scenario, liver grafts harboring benign tumors or large cysts represent an infrequent but potentially valuable source of viable grafts. We depict a challenging case of liver transplantation performed using a graft harboring two large Echinococcus granulosus hydatid cysts in close proximity with the hilar plate and complicated by cystobiliary communication. Although liver transplantation using grafts with hydatid cyst has been rarely reported (three published cases), our case was peculiar as one of the cysts was located close to the hilum and was ruptured into the left hepatic duct. The graft was finally accepted taking into account the low risk profile of the recipient, the good quality and size of the remnant liver parenchyma, and only after complete resection of the cysts was achieved. Although the recipient had a complication due to biliary confluence necrosis, at 10-months follow-up he is in good health with normal hepatic function, and a graft that could have been otherwise discarded was successfully used. The decision process along with technical and management issues are discussed.
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Affiliation(s)
- Damiano Patrono
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Tandoi
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giorgia Rizza
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giorgia Catalano
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Mirabella
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Piero Celoria
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Silvia Corcione
- Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Mauro Salizzoni
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Renato Romagnoli
- General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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Pascal G, Azoulay D, Belghiti J, Laurent A. Hydatid disease of the liver. BLUMGART'S SURGERY OF THE LIVER, BILIARY TRACT AND PANCREAS, 2-VOLUME SET 2017:1102-1121.e3. [DOI: 10.1016/b978-0-323-34062-5.00074-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Brunetti E, Praticò L, Neumayr A, Maestri M, Tamarozzi F. Update on Treatment for Cystic Echinococcosis of the Liver. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0079-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Menekse E, Turan U, Özyazıcı S, Karateke F, Aziret M, Bali I, Ozaltun P, Das K, Kuvvetli A, Ozdogan M. A New Preoperative Categorization and Potential Preoperative Indicator for Cysto-Biliary Fistula in Hydatid Hepatic Disease. Int Surg 2016; 101:185-193. [DOI: 10.9738/intsurg-d-15-00243.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Abstract
The objective of this study was to determine the risk for cysto-biliary fistula (CBF) and preoperative predictive factors in patients with hepatic hydatid disease (HHD) with high levels of hepatobiliary enzymes (HLE) alone. The risk of CBF and predictive factors in patients with HHD whose only sign of fistula was HLE is unknown. A total of 116 patients without clinical and radiologic signs who were operated for HHD were categorized into 2 groups: patients with and without HLE. The patients with HLE were defined as “usual suspicious.” The potential preoperatively predictive factors for CBF were retrospectively analyzed in this group. Our data included 18.1% of patients (n = 21) with CBF and 69.2% of patients (n = 81) with HLE. The usual suspicious group contained 24.7% of patients (n = 20) with CBF. The risk of CBF was 11-fold higher in the usual suspicious group (95% confidence interval, 1.4–86.7). The red cell distribution width (RDW) was higher in patients with CBF than in patients without CBF in the usual suspicious group (P = 0.006). The performance of the RDW, with a cutoff value of 13.75%, was found to be suboptimal for predicting CBF for patients in the usual suspicious group (area under the curve, 0.661; 95% confidence interval, 0.525–0.798). We defined a new preoperatively high-risk group with HLE alone; this definition can help to identify patients at risk for preoperatively undetectable CBF. The RDW was not found to be sufficient for the discrimination of usual suspicious group with CBF.
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Affiliation(s)
- Ebru Menekse
- Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Umit Turan
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Sefa Özyazıcı
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Faruk Karateke
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mehmet Aziret
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ilhan Bali
- Department of General Surgery, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Pinar Ozaltun
- Department of Biostatistics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Koray Das
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Adnan Kuvvetli
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mehmet Ozdogan
- General Surgery Clinic, Adana Medline Hospital, Adana, Turkey
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Benkabbou A, Souadka A, Serji B, Hachim H, Mohsine R, Ifrine L, Belkouchi A, El Malki HO. Changing paradigms in the surgical management of cystic liver hydatidosis improve the postoperative outcomes. Surgery 2015; 159:1170-80. [PMID: 26747223 DOI: 10.1016/j.surg.2015.10.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/16/2015] [Accepted: 10/28/2015] [Indexed: 12/23/2022]
Abstract
AIM OF THE STUDY Our aim was to propose and examine the outcomes of a comprehensive strategy for the management of cystic liver hydatidosis (CLH) based on extensive intraoperative assessments and optimal management of cystobiliary communications. BACKGROUND DATA Although operative intervention remains the preferred treatment for CLH, and the presence of a cystobiliary communication remains a well-established predictive factor for postoperative complications, no internationally accepted management strategy integrates the specific management of cystobiliary communication into the choice of surgical approach. METHODS Early postoperative outcomes were compared before (1990-2004; P1 group; n = 664) and after (2005-2013; P2 group; n = 156) the implementation of a CLH surgical management strategy for CLH in our overall group of patients in subgroups selected by risk factors (as determined by multivariate analysis), and in 2 propensity score-matched groups. RESULTS Specific complications related to the hepatic procedure (intraabdominal complications) were independently associated with the presence of ≥ 3 cysts (P = .013), a fibrotic pericyst (P = .005), a cystobiliary communication (P < .001), and the P1 treatment period (P = .002). Between P1 and P2 groups, the rate of specific complications decreased in the overall group of patients with CLH (18.3% vs 4.5%; P < .001). The rate also decreased in risk factor-based subgroups: patients with ≥ 3 cysts (31.0% vs 4.0%; P = .005), a fibrotic pericyst (23.1% vs 9.2%; P = .011), and a cystobiliary communication (33.0% vs 13.2%; P = .006). After propensity score matching among 123 well-balanced matched pairs of patients, the overall complication rate, specific hepatic surgery-related complication rate, and median duration of hospital stay decreased between the P1 and P2 groups: 23.6% vs 12.2% (P = .02), 21.1% vs 4.9% (P < .001), and 7 vs 5 days (P < .001), respectively. CONCLUSION Implementation of a CLH surgical management strategy based on specific intraoperative assessment and optimal management of cystobiliary communications improved early postoperative outcomes.
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Affiliation(s)
- Amine Benkabbou
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Amine Souadka
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco.
| | - Badr Serji
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Hajar Hachim
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Raouf Mohsine
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Lahsen Ifrine
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Abdelkader Belkouchi
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Hadj Omar El Malki
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
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Borahma M, Afifi R, Benelbarhdadi I, Ajana FZ, Essamri W, Essaid A. Endoscopic retrograde cholangiopancreatography in ruptured liver hydatid cyst. Indian J Gastroenterol 2015; 34:330-334. [PMID: 26345677 DOI: 10.1007/s12664-015-0585-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/05/2015] [Indexed: 02/04/2023]
Abstract
One of the most common and serious complications of hepatic hydatid cyst disease is communication between the cyst and the biliary tree. Surgical management of biliary fistula is associated with high morbidity and mortality. We retrospectively reviewed the effectiveness of endoscopic treatment of ruptured hydatid cyst into intrahepatic bile ducts. Diagnosis of intrabiliary rupture of hydatid cyst was mostly suspected by acute cholangitis, jaundice, pain, and/or persistent external biliary fistula after surgery. The diagnosis was confirmed by radiology and endoscopic retrograde cholangiopancreatography (ERCP) findings. We retrospectively reviewed clinical, laboratory, imagery, and ERCP findings for all patients. The therapeutic methods performed were endoscopic sphincterotomy, extraction by balloon or Dormia basket, stenting, or nasobiliary drainage. Sixteen patients with ruptured hepatic hydatid cyst into bile ducts were seen in 9 years. Nine of 16 patients had a surgical history of hepatic hydatid cyst and three patients had a percutanous treatment history. We carried out ERCP with sphincterotomy and extraction of hydatid materials (extraction balloon n = 11; Dormia basket n = 5) or biliary drainage (nasobiliary drainage n = 1; biliary stenting n = 1). The fistula healed in 80 % of patients with a median time of 6 weeks [range, 1-12] after endoscopic treatment. ERCP was an effective method of treatment for hepatic hydatid cyst with biliary fistula.
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Affiliation(s)
- Mohamed Borahma
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco.
| | - Rajaa Afifi
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco
| | - Imane Benelbarhdadi
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco
| | - Fatima Zahra Ajana
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco
| | - Wafaa Essamri
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco
| | - Abdellah Essaid
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco
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Brustia R, Perdigao F, Colignon N, Scatton O. Hydatid biliocystic fistula-induced cholestasis. Clin Res Hepatol Gastroenterol 2015; 39:153-4. [PMID: 24997728 DOI: 10.1016/j.clinre.2014.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/29/2014] [Accepted: 05/12/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Raffaele Brustia
- Department of Hepatobiliary and Liver Transplantation Surgery, hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de médécine, université Pierre-et-Marie-Curie, Paris, France.
| | - Fabiano Perdigao
- Department of Hepatobiliary and Liver Transplantation Surgery, hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nikias Colignon
- Department of Radiology, hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Scatton
- Department of Hepatobiliary and Liver Transplantation Surgery, hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de médécine, université Pierre-et-Marie-Curie, Paris, France.
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Tamarozzi F, Vuitton L, Brunetti E, Vuitton DA, Koch S. Non-surgical and non-chemical attempts to treat echinococcosis: do they work? ACTA ACUST UNITED AC 2014; 21:75. [PMID: 25531730 PMCID: PMC4273701 DOI: 10.1051/parasite/2014071] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/11/2014] [Indexed: 12/14/2022]
Abstract
Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are chronic, complex and neglected diseases. Their treatment depends on a number of factors related to the lesion, setting and patient. We performed a literature review of curative or palliative non-surgical, non-chemical interventions in CE and AE. In CE, some of these techniques, like radiofrequency thermal ablation (RFA), were shelved after initial attempts, while others, such as High-Intensity Focused Ultrasound, appear promising but are still in a pre-clinical phase. In AE, RFA has never been tested, however, radiotherapy or heavy-ion therapies have been attempted in experimental models. Still, application to humans is questionable. In CE, although prospective clinical studies are still lacking, therapeutic, non-surgical drainage techniques, such as PAIR (puncture, aspiration, injection, re-aspiration) and its derivatives, are now considered a useful option in selected cases. Finally, palliative, non-surgical drainage techniques such as US- or CT-guided percutaneous biliary drainage, centro-parasitic abscesses drainage, or vascular stenting were performed successfully. Recently, endoscopic retrograde cholangiopancreatography (ERCP)-associated techniques have become increasingly used to manage biliary fistulas in CE and biliary obstructions in AE. Development of pre-clinical animal models would allow testing for AE techniques developed for other indications, e.g. cancer. Prospective trials are required to determine the best use of PAIR, and associated procedures, and the indications and techniques of palliative drainage.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Via Brambilla 74, 27100 Pavia, Italy - WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Via Taramelli 5, 27100 Pavia, Italy
| | - Lucine Vuitton
- Gastroenterology and Endoscopy Unit, Besançon University Hospital, Bd Fleming, 25000 Besançon, France - WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25000 Besançon, France
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Via Brambilla 74, 27100 Pavia, Italy - WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Via Taramelli 5, 27100 Pavia, Italy - Division of Tropical Infectious Diseases, San Matteo Hospital Foundation, Via Taramelli 5, 27100 Pavia, Italy
| | - Dominique Angèle Vuitton
- WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25000 Besançon, France
| | - Stéphane Koch
- Gastroenterology and Endoscopy Unit, Besançon University Hospital, Bd Fleming, 25000 Besançon, France - WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25000 Besançon, France
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The role of perioperative endoscopic retrograde cholangiopancreatography and biliary drainage in large liver hydatid cysts. ScientificWorldJournal 2014; 2014:301891. [PMID: 25431783 PMCID: PMC4241747 DOI: 10.1155/2014/301891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 12/29/2022] Open
Abstract
Background. The best surgical technique for large liver hydatid cysts (LHCs) has not yet been agreed on. Objectives. The objective of this study was to examine the role of perioperative endoscopic retrograde cholangiopancreatography (ERCP) and biliary drainage in patients with large LHCs. Methods. A 20-year retrospective study of patients with LHCs treated surgically at the University Clinical Center of Kosovo (UCCK). We divided patients into 2 groups based on treatment period: 1981–1990 (Group I) and 2001–2010 (Group II). Demographic characteristics (sex, age), the surgical procedure performed, complications rate, and outcomes were compared. Results. Of the 340 patients in our study, 218 (64.1%) were female with median age of 37 years (range, 17 to 81 years). 71% of patients underwent endocystectomy with partial pericystectomy and omentoplication, 8% total pericystectomy, 18% endocystectomy with capitonnage, and 3% external drainage. In Group I, 10 patients underwent bile duct exploration and T-tube placement; in Group II, 39 patients underwent bile duct exploration and T-tube placement. In addition, 9 patients in Group II underwent perioperative ERCP with papillotomy. The complication rate was 14.32% versus 6.37%, respectively (P = 0.001). Conclusion. Perioperative ERCP and biliary drainage significantly decreased the complication rate and improved outcomes in patients with large LHCs.
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50
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Dolay K, Akbulut S. Role of endoscopic retrograde cholangiopancreatography in the management of hepatic hydatid disease. World J Gastroenterol 2014; 20:15253-15261. [PMID: 25386073 PMCID: PMC4223258 DOI: 10.3748/wjg.v20.i41.15253] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/30/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Most cases of hepatic hydatid disease exhibit uncomplicated clinical course and management. However, the diagnosis and management of complicated hepatic hydatid disease is a special issue. One of the most common and serious complications of hepatic hydatid disease is the rupture of the cyst into intrahepatic bile ducts. The clinical appearance of intrabiliary rupture can range from asymptomatic to jaundice, cholecystitis, cholangitis, liver abscess, pancreatitis and septicemia. Current treatments for major ruptures can result in high morbidity and mortality rates. Furthermore, ruptures that cannot be diagnosed preoperatively can induce complications such as biliary fistulae, biloma, cavitary infection and obstructive jaundice. In the past, these complications were diagnosed and treated by surgical methods. Currently, complications in both the pre- and postoperative periods are diagnosed and treated by non-invasive or minimally invasive methods. In clinical practice, endoscopic retrograde cholangiopancreatography (ERCP) is indicated for patients with preoperative frank intrabiliary rupture in which hydatid elements are clearly seen in the bile ducts, or for biliary adverse events after surgery, including persistent biliary fistulae and jaundice. However, controversy concerning routine preoperative ERCP and prophylactic endoscopic sphincterotomy in patients suspected of having minor cystobiliary communications still remains. In this article, the role of ERCP in the diagnosis and management of hepatic hydatid disease during the pre- and postoperative periods is reviewed.
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