Asymptomatic occult cysto-biliary communication without bile into cavity of the liver hydatid cyst: A pitfall in conservative surgery

Ünalp, Haluk Recai; Baydar, Behlül; Kamer, Erdinç; Yılmaz, Yakup; İşsever, Halim; Tarcan, Ercüment

doi:10.1016/j.ijsu.2009.06.012

Cited by 35 publications

(55 citation statements)

References 23 publications

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“…In another study including 183 cases with occult and asymptomatic cysts, Unalp el al. (10) reported that a cyst diameter of more than 10 cm predicted post-operative bile leak. In the current study, we also found that the cyst diameter was a significant predictor for the presence of CBF.…”

Section: Discussionmentioning

confidence: 99%

“…cyst cases) (5,(8)(9)(10)) is usually asymptomatic and may be diagnosed intra-operatively (bile within the cyst) or post-operatively by an external biliary fistula through a drain or wound. Frank or major fistula is a wide communication between the cyst and the biliary system that allows the contents of the cyst to drain into the biliary system causing obstructive jaundice, cholangitis, secondary infection of the cyst, or even anaphylaxis (11).…”

Section: Introductionmentioning

confidence: 99%

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Cystobiliary communication in hepatic hydatid cyst: predictors and outcome

Nakeeb

Salem²,

Sorogy³

et al. 2017

Turk J Gastroenterol

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cystobiliary communication in hepatic hydatid cyst: predictors and outcome

Nakeeb

Salem²,

Sorogy³

et al. 2017

Turk J Gastroenterol

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“…Although this method seems to be the most complete treatment for hydatid disease, it is indicated when cysts have destroyed an entire lobe or segment, thus compressing the healthy parenchyma interrupting the bile ducts, or there is the need to resect draining zones of fistulised bile ducts. In such cases left or right hepatectomy or segmentectomy can be performed [12,[23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

JLRDT

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Introduction: Liver echinococcosis is still an endemic disease in Balkans. PAIR is actually considered the safest therapeutically approach for uncomplicated type I and II cysts, while surgery is indicated for type III or complicated cysts. It's commonly believed that radical surgery could be considered the most appropriate treatment for hydrated disease, but with higher risk of morbidity, much more for centrally located cysts, especially in low-resources hospitals.Aim of the study: According with the tendency in western countries and within a training project leaded by Veneto Region -Italy, we started in cooperation with the Division of Surgery of Peja Hospital Kosovo a prospective study to assess the safety and effectiveness of radical surgery also for centrally located cysts, when PAIR was contraindicated. Materials and Methods:From Feb 2006 to Apr 2010, 10 consecutive patients (6 Female, 4 males, mean age 31, 3± 14 yrs, range 8-54) with 16 cysts were treated for echinococcal liver disease in Surgical Division of Peja Hospital, Kosovo. All patients received Albendazole before operation and in the perioperative period. Medical therapy was discontinued the day after operation. One patient had recurrent echinococcal cysts after previous operation of partial cystectomy and T-tube placement in the biliary duct. Patients were classified to have peripherical (n=1) or centrally (n=9) located cysts when at least one of them was in close relationship with the main vascular and biliary structures. Other than laboratory tests, preoperative evaluation included in all patients abdominal ultrasound and CT scan.Results: Nine pts with 15 cysts underwent radical surgery and 1 patient underwent non radical operation (1 subtotal pericystectomy). Four of them had multiple cysts. Mean operative time was 236 min. Mean postoperative stay was 5, 2± 2, 52 days (range 3-10). No intra or postoperative complications were observed after radical surgery. A bile leak that healed spontaneously after 9 days occurred in patient with subtotal pericystectomy. Mean follow-up is longer than 3 years. Discussion: Therapeutic choices for echinococcal liver disease depend from factors related to patient, cyst, availability of resources and physician. Radical surgery is considered the treatment of choice because of complete elimination of the parasite and the residual cavity, minimizing the risk of recurrence. This approach, especially for central cysts, must be balanced with the risk of complications, but it's the preferred one in Centers with expertise in liver surgery and it was possible in 93% of cases in this series. In our experience mean operative time was prolonged because of meticulous dissections of cysts from surrounding tissue and vessels. It was always possible to dissect the main veins from pericystium, while portal triad structures were more often eroded by the cysts and needed to be sutured. Mean follow-up is more than 3 years and no recurrences were observed until now. Conclusion:Open radical surgery can be considered a reliable...

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“…Liver hydatidosis is a zoonotic disease which is caused by the larvae of the genus Echinococcus and is endemic to certain areas of the planet [1,2,3,4,5,6,7,8,9,10,11,12,13]. Among the complications that liver hydatid cysts (LHC) may cause, the most common (and the most serious) is communication between the LHC and the bile duct [3,4,5,6,7,8,9,10,11,12,13,14].…”

Section: Introductionmentioning

confidence: 99%

“…Among the complications that liver hydatid cysts (LHC) may cause, the most common (and the most serious) is communication between the LHC and the bile duct [3,4,5,6,7,8,9,10,11,12,13,14]. Cystobiliary communication (CBC) may occur anywhere in the bile duct.…”

Section: Introductionmentioning

confidence: 99%

Frank Intrabiliary Rupture in Liver Hydatidosis Located in the Hilar Plate: A Surgical Challenge

et al. 2013

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Background: Frank intrabiliary rupture (FIR) is a severe complication that occurs in around 30% of patients with liver hydatidosis. When FIR is present, the contents of the cyst may pass into the common bile duct and cause a variety of complications. If the FIR is located in the hilar confluence, surgical repair is a challenge. Currently there are no data regarding its optimum treatment. Material and Methods: Between May 2007 and December 2012, we treated 59 patients with liver hydatidosis. Four patients, all women, with a mean age of 51.7 years, had hydatid cysts located between segments IVb and V and FIR affecting the hilar plate. In 3 cases, the initial clinical condition was obstructive jaundice. The fourth patient presented recurrence after having undergone two operations as a child. Results: In each patient a major hepatectomy was performed with hilar plate reconstruction (3 left and 1 right). Morbidity included mild biliary fistula (1 patient) and abdominal collection resolved by percutaneous drainage (1 patient). There was no mortality. During follow-up (47 months), no recurrences of the disease or biliary strictures were recorded. Conclusions: FIR is a severe complication of liver hydatidosis. When it is located in the hilar confluence, liver resection may be the best surgical option for definitive resolution of the problem.

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Asymptomatic occult cysto-biliary communication without bile into cavity of the liver hydatid cyst: A pitfall in conservative surgery

Abstract: The predictors demonstrated in this study should allow the likelihood of occult insidious cysto-biliary communication to be determined and, thus, indicate the need for additional procedures during operations to prevent the complications of biliary leakage.

Cited by 35 publications

References 23 publications

Cystobiliary communication in hepatic hydatid cyst: predictors and outcome

Cystobiliary communication in hepatic hydatid cyst: predictors and outcome

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Frank Intrabiliary Rupture in Liver Hydatidosis Located in the Hilar Plate: A Surgical Challenge

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