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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
Different methods have been used to treat hydatid cyst of the liver but there are no conclusive results. The two most common complications are postoperative biliary fistula and recurrent hydatid cyst disease (HCD).
Research motivation
We were motivated to conduct this study to evaluate the incidence of occult cysto-biliary communication (CBC) and HCD recurrence after laparoscopic partial resection and omentoplasty.
Research objectives
The objectives of the study were to determine the incidence of occult CBC and HCD recurrence rate with the aim of reducing these two complications. The second objective was to detect an association between high cystic fluid biochemical indices and the incidence of developing postoperative biliary fistula and HCD recurrence.
Research methods
A prospective observational study was conducted involving 244 patients with stage cystic echinococcosis 2 and cystic echinococcosis 3b according to the World Health Organization’s Informal Working Group on Echinococcosis classification who underwent laparoscopic partial cystectomy with omentoplasty.
Research results
There was a highly statistically significant association between cystic fluid biochemical indices and the development of biliary complications. There was a highly statistically significant association between biliary complications, biochemical indices, and the occurrence of recurrent HCD.
Research conclusions
This study is the first to propose that occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and alkaline phosphatase levels predicted POBF and recurrent HCD. These findings will encourage surgeons to detect occult CBCs to avoid morbidity and mortality due to POBF and recurrent HCD.
Research perspectives
Future studies should focus on the detection of CBCs to decrease the incidence and morbidity of POBF and HCD recurrence.
