[Internal trans-Oddi's sphincter fistula drainage of hydatid cysts communicating with the bile ducts]

The purpose of this study was to examine the contribution of internal trans-fistulary drainage without opening the cystic cavity for the treatment of hydatic cyst of the liver.

Between 1985 and 1990, 14 patients with hydatid cyst of the liver communicating with the bile duct were treated by internal trans-fistulary drainage without opening the hydatic cavity. Choledocoscopy demonstrated good bile flow without a remaining cystic fragment in all cases. The residual cavity was drained via an external drain in the common bile duct. A second hydatic cyst of the liver was also treated in 4 patients.

Internal trans-fistulary drainage was achieved easily. There were two treatment-related postoperative complications: bilary leakage in one patient and infection of the residual cavity leading to septicemia and death in another.

Internal trans-fistulary drainage without opening the hydatic cavity is indicated for central hydatic cyst of the liver measuring less than 15 cm with a flexible pericyst and a large biliocystic fistula measuring more than 5 mm. Peroperative choledochoscopy of the hydatic cavity is necessary.