Cystobiliary communication in hepatic hydatid cyst: predictors and outcome

Cystobiliary communication (CBF) with hepatic hydatid disease is responsible for postoperative bile leakage after surgical management. This study aims to detect various predictors of CBF and its outcome after surgical management. This is a retrospective, cohort study of all patients who underwent surgical management for hydatid disease of the liver. Patient data were recorded on an internal web-based registry system supplemented by paper records. Patients were classified into two groups according to the presence of CBF: group (A) patients with CBF and group (B) patients without CBF. There were 123 patients with a hepatic hydatid cyst with a mean age of 39.92±14.59 years. Patients were classified into group (A), 26 patients (21.1%) with CBF, and group (B), 97 patients (78.9%) without CBF. The age group (p=0.04), presence of jaundice (p=0.001), serum glutamic-pyruvic transaminase (SGPT) (p=0.001), cyst size (p=0.0001), and cyst size group (>10 cm) (p=0.0001) were associated with CBF. That cyst size was the only independent predictor of the occurrence of CBF. Intraoperative suturing and the T tube led to complete healing of CBF, and postoperative endoscopic retrograde cholangio-pancreatography (ERCP) and tubal drainage led to a rapid reduction in the bile output and the healing of the fistulas after 9±2.6 days. That cyst size was the only independent predictor for the occurrence of CBF. Management is related to the size of the fistula, the site of the cyst, and the experience of the hepatobiliary surgeon. ERCP is an important option for the management of CBF.