A New Preoperative Categorization and Potential Preoperative Indicator for Cysto-Biliary Fistula in Hydatid Hepatic Disease

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 ¼ 21) with CBF and 69.2% of patients (n ¼ 81) with HLE. The usual suspicious group contained 24.7% of patients (n ¼ 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 ¼ 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

Turkish HPB Surgery Association consensus report on hepatic cystic Echinococcosis (HCE)

“…For the detection of biliary fistula in the preoperative period, in addition to the biochemical parameters that indicate biliary tract obstruction, which we mentioned in the previous section, studies have also identified elevated AST and ALT enzymes as a risk factor (100,101,113).…”

“…Retrospective clinical studies are predominant in the literature on predictive parameters in detecting hydatid cysts with biliary fistula in the preoperative period. Many articles have reported elevations in the enzymes (ALP, GGT, Total and Total Direct Bilirubin) that indicate biliary duct obstruction (98)(99)(100)(101). Literature indicates an increase in the biliary tract relationship with the increasing cyst size, and studies have reported a cut-off value between 7.5-14 cm (98,99,(102)(103)(104).…”