Changing paradigms in the surgical management of cystic liver hydatidosis improve the postoperative outcomes

Aim of the study Our aim was to propose and examine the outcomes of a comprehensive strategy for the management of cystic liver hydatidosis (CLH) based on extensive intraoperative assessments and optimal management of cystobiliary communications. Background data Although operative intervention remains the preferred treatment for CLH, and the presence of a cystobiliary communication remains a well-established predictive factor for postoperative complications, no internationally accepted management strategy integrates the specific management of cystobiliary communication into the choice of surgical approach. Methods Early postoperative outcomes were compared before (1990–2004; P1 group; n = 664) and after (2005–2013; P2 group; n = 156) the implementation of a CLH surgical management strategy for CLH in our overall group of patients in subgroups selected by risk factors (as determined by multivariate analysis), and in 2 propensity score–matched groups. Results Specific complications related to the hepatic procedure (intraabdominal complications) were independently associated with the presence of ≥3 cysts ( P = .013), a fibrotic pericyst ( P = .005), a cystobiliary communication ( P