Factors associated with morbitity in liver hydatid surgery

The role of perioperative endoscopic retrograde cholangiopancreatography and biliary drainage in large liver hydatid cysts

Background. The best surgical technique for large liver hydatid cysts (LHCs) has not yet been agreed on. Objectives. The objective of this study was to examine the role of perioperative endoscopic retrograde cholangiopancreatography (ERCP) and biliary drainage in patients with large LHCs. Methods. A 20-year retrospective study of patients with LHCs treated surgically at the University Clinical Center of Kosovo (UCCK). We divided patients into 2 groups based on treatment period: 1981–1990 (Group I) and 2001–2010 (Group II). Demographic characteristics (sex, age), the surgical procedure performed, complications rate, and outcomes were compared. Results. Of the 340 patients in our study, 218 (64.1%) were female with median age of 37 years (range, 17 to 81 years). 71% of patients underwent endocystectomy with partial pericystectomy and omentoplication, 8% total pericystectomy, 18% endocystectomy with capitonnage, and 3% external drainage. In Group I, 10 patients underwent bile duct exploration and T-tube placement; in Group II, 39 patients underwent bile duct exploration and T-tube placement. In addition, 9 patients in Group II underwent perioperative ERCP with papillotomy. The complication rate was 14.32% versus 6.37%, respectively (P = 0.001). Conclusion. Perioperative ERCP and biliary drainage significantly decreased the complication rate and improved outcomes in patients with large LHCs.

Risk factors of postoperative morbidity in patients with uncomplicated liver hydatid cyst

PURPOSE

To determine postoperative morbidity (POM) in patients undergoing surgery for uncomplicated hepatic echinococcosis (HE) and determine associations with the variable POM looking for possible risk factors for POM.

METHODS

Nested case-control study. We included patients undergoing surgery for uncomplicated HE in two hospitals in Temuco between 2000 and 2012. The main outcome variable was development of POM. Other variables of interest were hospital stay, mortality and recurrence. Surgical techniques used were pericystectomy and liver resection. Descriptive statistics and analytical statistics were applied using T-test, ANOVA and Kruskal-Wallis test to compare continuous variables; Chi(2) and Fisher's exact test for categorical variables, and logistic regression models were used, estimating OR.

RESULTS

126 patients, median age 41 years, 61% female. The incidence of POM was 10.3%, with 76.9% Clavien grade I or II. The etiology was 6.5% and 4.1% of medical and surgical complications, respectively. There was no mortality and with a median follow-up of 83 months, recurrence incidence was 0.8%. Association was found between cases and controls and the variables age, alkaline phosphatase, cyst location and hospital stay. Applying regression models age (p = 0.002 and OR 1.07) and cyst location (p = 0.003 and OR 3.94) were found to be risk factors.

CONCLUSIONS

Observed POM is lower and of less severity than those previously published. Risk factors were determined.

Treatment of the residual cavity during hepatic hydatidosis surgery: a cohort study of capitonnage vs. omentoplasty

PURPOSE

To determine the efficacy of omentoplasty (OP) and capitonnage (CA) in residual cavity management during the hepatic hydatidosis (HH) surgery in terms of the postoperative morbidity.

METHODS

Prospective cohort study. Patients with non-complicated HH treated with subtotal pericystectomy in the Department of Surgery of the Temuco Regional Hospital between 2001 and 2008 were studied. We compared those managed with CA with those managed with OP. A sample size of 40 patients in each group was estimated to be needed to adequately compare the outcomes of the approaches. The primary endpoint was postoperative morbidity. Descriptive statistics, bivariate analyses and logistic regression models were applied. The absolute risk (AR) and relative risk (RR) were calculated.

RESULTS

The cohorts comprised 88 patients (CA 40 and OP 48), with a median age of 40 years (15-84), and 62.5 % were females. A general postoperative morbidity rate of 11.4 % was noted after a median follow-up of 60 months (12-84 months). Significant differences in postoperative morbidity were found (p = 0.044). Logistic regression models verified that there were no confounding variables. The AR of the postoperative morbidity for the CA and PO cohorts was 0.025 and 0.1875, respectively, and the RR was 0.13 [0.03, 0.70] 95 % CI.

CONCLUSION

Residual cavity management with CA is associated with a lower postoperative morbidity risk than OP.

Hydatid cyst open in biliary tract: therapeutic approaches. Report of 22 cases

GOAL

Discuss the different therapeutic options based on results of a series of patients undergoing operation for hydatid cyst ruptured into the biliary tract.

PATIENTS AND METHODS

This was a retrospective study of 22 patients operated on between 2001 and 2007 for hydatid cyst ruptured into the biliary tract.

RESULTS

The mean age of patients was 37 years old. There were 14 men and eight women. Cholangitis was present in 59% of patients and isolated pain in the right upper quadrant was found in 20% of patients. Procedures performed included internal fistula drainage through the sphincter of Oddi (37.3%), cystobiliary disconnection by percutaneous transhepatic cystocholedochostomy (27.3%), bipolar drainage (27.3%), direct suture closure of the fistula (9.1%). The postoperative course was uneventful in 15 patients. Specific morbidity concerned four patients. An external biliary fistula and suppuration of the residual cavity was observed in two patients each. One patient died. Median survival was 24 months. No recurrence or late complications were seen in this series.

CONCLUSION

The management of hydatid cyst ruptured into the biliary tract is not consensual. Radical treatment is best because it provides definitive treatment of both the fistula and the cyst at the same time. However, conservative treatment is the preferred treatment in endemic countries. The choice of the technique depends of the experience of the surgeon, as well as local and topographic conditions. The best treatment remains preventive by eradication of echinococcosis.

Intrabiliary rupture of hepatic echinococcosis, a risk factor for developing postoperative morbidity: a cohort study

BACKGROUND

The aim of this study was to determine if intrabiliary rupture (IBR), an evolutive complication of hepatic echinococcosis (HE), is a risk factor for developing postoperative morbidity (POM).

METHODS

This was a concurrent cohort study that included patients operated on for HE between 1996 and 2006 and who had clinical check-ups at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Principal outcome variable was "development POM," considered dichotomously. The exposure variable was the presence of IBR, analyzed dichotomously (present or absent) and according to the number of IBR (without, with one, and with two or more). The sample size was considered on the basis of a 95% confidence interval (95% CI), a power of 80%, a 1:2 ratio of patients without and with IBR, and a 10% proportion of POM in patients without IBR and 26% in patients with IBR. Descriptive statistics and bivariate and multivariate analyses were used. Relative risks (RR) and 95% CI were calculated.

RESULTS

The cohorts (median age of 42 years, 56.4% female, a median cyst diameter of 15 cm, and a follow-up of 118 months) were composed of 96 patients without IBR (38.1%) and 156 patients with IBR (61.9%). A morbidity rate of 17.1% was verified (9.4% in the group without IBR and 21.8% in the group with IBR [p = 0.011]). An adjusted RR of 3.4 (95% CI = 2.64, 4.18) was verified for the comparison of subgroups without IBR vs. with two or more IBR (p < 0.001).

CONCLUSION

The presence of two or more IBR constitutes a risk factor for developing POM in patients with HE.

Experience with the surgical treatment of hepatic hydatidosis: Case series with follow-up

AIM: To describe patient characteristics and the results of surgical treatment for hepatic hydatidosis (HH) in the Hospital Hernán Henríquez Aravena from December 2001 to March 2005.

METHODS: Subjects older than 16 years with suspected HH were included based on the clinical picture and radiological studies. Variables examined included clinical and laboratory aspects, outcome, features of the parasite and surgical aspects. Descriptive statistics were used, calculating central tendency, dispersion and extreme tendency.

RESULTS: The series was comprised of 122 patients, with an average age of 44 ± 16.9 years. The most frequently used surgical technique was subtotal cystectomy in 90% of the patients, followed by hepatic resection (hepatectomy, segmentectomy and subsegmentectomy) in 5%. In 2%, a combination of subtotal cystectomy and segmentectomy was performed. In addition, 28% of the series presented complications in the postoperative period and mortality was 2%.

CONCLUSION: The most frequently used surgical technique for HH was subtotal cystectomy and the morbidity and mortality rates in this Chilean series are comparable to other national and international series.

Hepatic venous outflow obstruction after hydatid cyst surgery: evaluation with contrast enhanced magnetic resonance angiography

INTRODUCTION

The aim of this study is to present the contrast enhanced magnetic resonance angiography findings of hepatic venous outflow obstruction in patients in whom surgery had been performed for hepatic hydatidosis. No patient history of parasitic hepatic venous invasion or earlier hepatic venous outflow obstruction is present.

MATERIALS AND METHODS

Four men and three women with a history of hydatid cyst surgery underwent contrast enhanced magnetic resonance angiography between April 2001 and June 2006. The mean age was 37.7 years. The mean time duration between the last date of surgery and the date of magnetic resonance angiography imaging was 65.5 months. The site of the hydatid cyst was the right lobe in two patients, the medial segment of the left lobe in two patients, the liver dome in two patients, and the conjunction of the right lobe anterior-left lobe medial segments in one patient. One patient had undergone total and one patient had undergone partial lobectomy, and cystectomy was performed in five patients.

RESULTS

On magnetic resonance angiograms, nonvisualization or stenosis of the hepatic veins was detected in all cases. In one patient thrombosis and in another patient severe stenosis of the inferior vena cava were associated. The portal hilum was displaced anterosuperiorly in five patients. Intrahepatic collaterals were present in six patients and extrahepatic collaterals were seen in three. Associated thrombosis in the left portal vein was found in two patients.

CONCLUSION

We conclude that patients with complicated hydatid cysts and who have had postoperative complications should be checked not only for recurrence or abscess formation, but also for vascular changes. magnetic resonance angiography is a useful alternative imaging technique and can provide useful information at one session within several minutes in patients who had undergone surgery for hydatid cyst of the liver.