Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Sep 20, 2023; 13(4): 272-286
Published online Sep 20, 2023. doi: 10.5662/wjm.v13.i4.272
Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study
Tamer A A M Habeeb, Mauro Podda, Boris Tadic, Vishal G Shelat, Yaman Tokat, Mohamed Ibrahim Abo Alsaad, Abd-Elfattah Kalmoush, Mohammed Shaaban Nassar, Fawzy Metwally Mustafa, Mahmoud Hassib Morsi Badawy, Mohamed Sobhy Shaaban, Tarek Zaghloul Mohamed, Mohammed Ibrahim El Sayed Henish, Hamdi Elbelkasi, Mahmoud Abdou Yassin, Abdelshafy Mostafa, Amr Ibrahim, Waleed A-Abdelhady, Tamer Mohamed Elshahidy, Mohamed Ibrahim Mansour, Adel Mahmoud Moursi, Mohamed Abdallah Zaitoun, Ehab Shehata Abd-Allah, Ashraf Abdelmonem Elsayed, Rasha S Elsayed, Ahmed M Yehia, Amr Abdelghani, Mohamed Negm, Heba Alhussein Abo-Alella, Mostafa M Elaidy
Tamer A A M Habeeb, Mahmoud Abdou Yassin, Abdelshafy Mostafa, Amr Ibrahim, Waleed A-Abdelhady, Tamer Mohamed Elshahidy, Mohamed Ibrahim Mansour, Adel Mahmoud Moursi, Mohamed Abdallah Zaitoun, Ehab Shehata Abd-Allah, Ashraf Abdelmonem Elsayed, Rasha S Elsayed, Ahmed M Yehia, Amr Abdelghani, Mohamed Negm, Heba Alhussein Abo-Alella, Mostafa M Elaidy, 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
Mohamed Ibrahim Abo Alsaad, Department of General Surgery, Faculty of Medicine -Merit University, Sohag 82511, Egypt
Abd-Elfattah Kalmoush, Mohammed Shaaban Nassar, Fawzy Metwally Mustafa, Mahmoud Hassib Morsi Badawy, Mohamed Sobhy Shaaban, Tarek Zaghloul Mohamed, Mohammed Ibrahim El Sayed Henish, 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
Author contributions: All authors contributed to the study conception and design, material preparation, data collection, and analysis; All authors commented on the previous versions of the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board Committees, No. IRB10032.
Clinical trial registration statement: This study is registered at https://clinicaltrials.gov/. The registration identification number is ID: NCT05116735.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data are available from the corresponding author on reasonable request at tameralnaimy@hotmail.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tamer A A M Habeeb, MD, Professor, Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt. tameralnaimy@hotmail.com
Received: March 22, 2023
Peer-review started: March 22, 2023
First decision: June 14, 2023
Revised: June 16, 2023
Accepted: June 27, 2023
Article in press: June 27, 2023
Published online: September 20, 2023
Processing time: 181 Days and 21.3 Hours
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.

Keywords: Cysto-biliary communication; Echinococcus granulosus; Hydatid disease recurrence; Hydatid fluid analysis; Laparoscopy

Core Tip: There has been no research on occult cysto-biliary communication (CBC) prediction for recurrent hydatid cyst disease (HCD) or the role of elevated cyst fluid bilirubin and alkaline phosphatase (ALP) levels in predicting postoperative biliary fistula and recurrent HCD. The main finding of this study was that there was a statistically significant association (P ≤ 0.001) between biochemical indices and the development of biliary complications, where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association between biliary complications, biochemical indices, and the occurrence of 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.