International Journal of Medical Sciences
Can Occult Cystobiliary Fistulas in Hepatic Hydatid Disease Be Predicted Before Surgery?
Kemal Atahanƒx, Hakan Kupeli, Mehmet Deniz, Serhat Gur, Atilla Cokmez, Ercument Tarcan
Atatürk Educational and Research Hospital 1st Surgical Department, فzmir, Turkey
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 be-tween 2003 and 2008 were reviewed retrospectively. The patients who had jaundice history, preoperative high total bilirubin and direct bilirubin levels, dilated bile duct in preoperative radiologic imagings were not included the study. Patients were divided into two groups: group A; without postoperative biliary fistula, group B; with biliary fistula. The two groups were compared according to preoperative descriptive findings, cystic specialties, and laboratory findings.
Results: There were 53 patients and 15 patients in groupA and groupB, respectively. The 20 (37.7%) of 53 patients were male in group A and the 10 (66.7%) patients were male in group B (p<0.05). The age, number of cysts, Garbi scores of cysts, the rate of recurrent cysts, the level of preoperative bilirubine, alkalene phosphatase, and transaminases were similar in both groups (p>0.05). GGT was significantly different between two groups (p<0.05). The cys-totomy + drainage, cystotomy + omentopexy, and intracystic biliary suture rates were similar in both groups. Postoperative non biliary complications were determined in 4 (7.5%) patients in group A and 7 patients (46.7%) in group B (p<0.05). Hospital stay was longer in group B significantly (p<0.05).
Conclusions: In conclusion, GGT as a labaratory test for predicting occult CBC preopera-tively have been shown to be useful in the clinical practice. However, larger prospective studies are needed on this subject. Occult cysto-biliary fistulas can only be exposed during surgery when suspected by a surgeon. If occult CBC is found, the opening in the biliary system should be sutured with absorbable material, with or without cystic duct drainage. If no biliary opening is found, cystic duct drainage may be performed if preoperative factors predict the presence of CBC. As the development of external biliary fistulas increases the morbidity and the hospitalization period, novel surgical methods to prevent the development of bile fistulas are required in such patients.
Biliary fistulas, cystobiliary communication, hepatic hydatid disease, cyst, surgery
Date Deposited : 04 Jul 2011 11:09
Last Modified : 04 Jul 2011 11:09
Official URL: http://www.medsci.org/
Volume 8, Number 4, - 2011 , ISSN 1449-1907