Occult cystobiliary communication presenting as postoperative biliary leakage after hydatid liver surgery: are there significant preoperative clinical predictors?
نویسندگان
چکیده
BACKGROUND Occult cystobiliary communication (CBC) presents with biliary leakage, if the cystobiliary opening cannot be detected and repaired at operation. We investigated the clinical signs associated with the risk of occult CBC in the preoperative period by studying patients who developed biliary leakage after hydatid liver surgery. METHODS We analyzed the records of 191 patients treated for hydatid liver cyst. Postoperative biliary leakage developed in 41 patients (21.5%). Independent predictive factors were established by logistic regression analysis using clinical parameters, whose cutoff values were determined by receiver operating characteristic (ROC) curves. RESULTS Postoperative biliary leakage presented as external biliary fistula in 31 (75.6%) of 41 patients, as biliary peritonitis in 6 (14.6%) and as cyst cavity biliary abscess in 4 (9.8%). Independent clinical predictors of occult CBC, represented by biliary leakage, were alkaline phosphatase > 250 U/L, total bilirubin > 17.1 micromol/L, direct bilirubin > 6.8 micromol/L, gamma-glutamyl transferase > 34.5 U/L, eosinophils > 0.09 and cyst diameter > 8.5 cm. Multilocular or degenerate cysts increased the risk of biliary leakage (p = 0.012). Postoperative complication rates were 53.7% in the patients with biliary leakage, and 10.0% (p < 0.001) in those without. The mean postoperative hospital stay was longer in patients with biliary leakage (14.3 [and standard deviation {SD} 1.9] d) than in those without (7.3 [SD 2.3] d) (p < 0.001). Nineteen (61.3%) of 31 biliary fistulae closed spontaneously within 10 days. The remaining 12 (38.7%) fistulae closed within 7 days after endoscopic sphincterotomy. CONCLUSION Factors that predict occult CBC due to hydatid liver cyst were identified. These factors should allow the likelihood of CBC to be determined and, thus, indicate the need for additional procedures during operation to prevent the complications of biliary leakage.
منابع مشابه
Can Occult Cystobiliary Fistulas in Hepatic Hydatid Disease Be Predicted Before Surgery?
BACKGROUND Biliary fistulas because of the cystobiliary communication is the most frequent and undesirable postoperative complication of hepatic hydatid surgery. We aimed to identify the predicting factors of the occult cystobiliary communication in this study. METHODS The patients who underwent surgical treatment for hepatic hydatid disease between 2003 and 2008 were reviewed retrospectively...
متن کاملLeakage tests reduce the frequency of biliary fistulas following hydatid liver cyst surgery
BACKGROUND AND AIM Biliary fistulas are the most common morbidity (8.2-26%) following hydatid liver surgery. The aim of our study was to reduce the incidence of postoperative biliary fistulas after the suturing of cystobiliary communications by applying a bile leakage test. PATIENTS AND METHODS A total of 133 hydatid liver cysts from 93 patients were divided into two groups, according to whet...
متن کاملValue of cyst localization to predict cystobiliary communication in patients undergoing conservative surgery with hydatid cyst
OBJECTIVE The objectives of this study were to investigate the relationship between the segmental localization of liver hydatid cyst by computed tomography (CT) and the presence of cystobiliary communication (CBC) and to identify the risk factors for CBC. PATIENTS AND METHODS One hundred and eleven of 163 patients who underwent liver hydatid surgery between January 2011 and September 2014 wer...
متن کاملIntraoperative diagnosis of cystobiliary communications of hydatid liver cysts
The liver is the most frequent location for hydatid disease, and the most common complication of hydatid liver cysts is cystobiliary communications. Prevention methods for this frequent complication can decrease postoperative interventions and the duration of hospital stay. Technical details of the surgical methods are very useful for clinicians who treat hydatid cysts. We would like to thank I...
متن کاملConcomitant Rupture of Hydatid Cyst of Liver in Hepatic Duct and Gallbladder: Case Report
Hydatid cyst liver rupture into the biliary tree may involve the common hepatic duct, lobar biliary branches, the small intrahepatic bile ducts or rarely the gallbladder. Rupture can be occult or frank. A frank intrabiliary rupture of hepatic hydatid cyst is a rare but serious event. The authors are reporting a case of concomitant rupture of hydatid cyst of liver into right hepatic duct and the...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Canadian journal of surgery. Journal canadien de chirurgie
دوره 49 3 شماره
صفحات -
تاریخ انتشار 2006