Biliary Complications of Hepatic Hydatid Cyst Surgery and Prevention Methods

Abstract

Cystic echinococcosis is still one of the main reasons for liver surgery especially in endemic areas. The most common complication of liver hydatid cyst is cystobiliary communication (CBC). Preoperative or intraoperative diagnosis of CBC is essential for the treatment, since it leads to postoperative bile leakage and fistula formation eventually without intervention. Predictive factors such as cyst size, history of jaundice, and degenerated cysts are described for preoperative evaluation. Further preoperative study can be performed for diagnosis in their presence. At the intraoperative phase, every effort should be performed for diagnosis. There are several methods for the investigation of CBC. When a CBC is found, it is also essential to evaluate the biliary system as well. By this way, postoperative complication rates can be lowered. Biliary leakage and fistula formation are the most common postoperative complication of liver hydatid surgery and they are the main reasons of morbidity and mortality. Their rates can be lowered by knowing how to interfere for the treatment. As a result, every effort should be made to detect and prevent these complications during the evaluation and management of cystic echinococcosis.

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

“…Literature in the 90s reported that the treatment of hydatid cyst was surgical, and if the cyst was associated with the biliary tract during surgery, T-tube drainage might be required, and preoperative preparation should be made (126). However, today, with the advancement of radiological imaging, cysto-biliary communication can be better demonstrated preoperatively, and sphincterotomy and preoperative ERCP reduce the risk of postoperative bile leakage (124,126).…”

“…Literature in the 90s reported that the treatment of hydatid cyst was surgical, and if the cyst was associated with the biliary tract during surgery, T-tube drainage might be required, and preoperative preparation should be made (126). However, today, with the advancement of radiological imaging, cysto-biliary communication can be better demonstrated preoperatively, and sphincterotomy and preoperative ERCP reduce the risk of postoperative bile leakage (124,126). There are also recommendations in the literature for the use of ERCP to reduce bile duct pressure and clear debris in hydatid cysts with an obvious cysto-biliary communication, since the incidence of detecting bile duct association greater than 5 mm is 65%, while the incidence of detecting biliary fistula below 5 mm is between 10-37% (112,126,127).…”

“…However, today, with the advancement of radiological imaging, cysto-biliary communication can be better demonstrated preoperatively, and sphincterotomy and preoperative ERCP reduce the risk of postoperative bile leakage (124,126). There are also recommendations in the literature for the use of ERCP to reduce bile duct pressure and clear debris in hydatid cysts with an obvious cysto-biliary communication, since the incidence of detecting bile duct association greater than 5 mm is 65%, while the incidence of detecting biliary fistula below 5 mm is between 10-37% (112,126,127). In patients with signs of sepsis, such as hydatid cyst rupture, which require an emergency operation, it would be appropriate to try surgical methods for the cysto-biliary communication by taking them directly to the operating room without ERCP (107,108,111).…”