Predictive factors of occult cystobiliary fistulas during conservative treatment of hepatic hydatid cyst: a prospective study

Occult cystobiliary fistula (CBF) is a common complication of hepatic hydatid cyst (HHC). It is often the cause of high morbidity of conservative treatment of HHC. This study aimed to determine the predictive factors of occult CBF to establish the indications for the investigation and treatment of t...

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Published in:Journal of gastrointestinal surgery 2024-02, Vol.28 (2), p.108-114
Main Authors: Trigui, Aymen, Fendri, Sami, Akrout, Amira, Trabelsi, Jihen, Daoud, Rahma, Saumtally, Mohamed Saad, Ketata, Salma, Baklouti, Soulaymen, Boujelbene, Wael, Mzali, Rafik, Dziri, Chadli, Rejab, Haithem, Boujelbene, Salah
Format: Article
Language:English
Subjects:
Biliary fistulas
Cataract - congenital
Conservative Treatment
Cysts
Echinococcosis
Echinococcosis, Hepatic - complications
Echinococcosis, Hepatic - surgery
Fistula
Hepatic
Humans
Iron Metabolism Disorders - congenital
Prospective Studies
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Summary:Occult cystobiliary fistula (CBF) is a common complication of hepatic hydatid cyst (HHC). It is often the cause of high morbidity of conservative treatment of HHC. This study aimed to determine the predictive factors of occult CBF to establish the indications for the investigation and treatment of these CBFs. This was a prospective study that included all operated HHCs over a 3-year period. HHCs complicated with large CBFs were not included in the study. Systematic cholecystectomy and methylene blue test for all cysts were performed. A total of 46 patients operated on with 113 cysts were included in this study. The median cyst size was 6.7 cm (IQR, 1-38). A total of 114 CBFs were detected in 51 cysts (45.1%). The postoperative course was simple in 95.0% of cases. The specific morbidity rate was 2.7%. In a bivariate study, absence of mass and abdominal pain on palpation, hemoglobin level >11.55 g/dL, negative hydatid serology, cyst size, absence of calcifications, vascular compression, existence of a single cyst, and localization at segment VIII were predictive factors of occult CBF. At the end of the multivariate study, cyst size was determined to be the only predictive factor for occult CBF. A threshold of 3 cm was used. Cyst size is a major predictive factor for occult CBF.
ISSN:1091-255X
1873-4626
DOI:10.1016/j.gassur.2023.11.011