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Factors predictive of frank intrabiliary rupture in patients with hepatic hydatid cysts
Ahmed Z Al-Bahrani1, Mohammed Al-Maiyah, Basil J Ammori
1Department of Surgery, Medical City Teaching Hospital, Baghdad, Iraq.
Insights
Frank intrabiliary rupture (IBR) in hepatic hydatid cysts (HHC) is predicted by large, infected, multivesicular, solitary, or left lobar cysts. Prolonged symptoms also increase the risk of IBR, necessitating early surgical intervention for at-risk patients.
Area of Science:
- Hepatobiliary surgery
- Parasitic diseases
- Surgical complications
Background:
- Frank intrabiliary rupture (IBR) is a significant complication of hepatic hydatid cysts (HHC), affecting 3-17% of patients.
- Identifying predictors of IBR is crucial for timely management and improved patient outcomes.
Purpose of the Study:
- To determine the independent predictors of frank intrabiliary rupture (IBR) in patients with hepatic hydatid cysts (HHC).
Main Methods:
- A retrospective analysis of 741 patients who underwent surgery for HHC between 1965 and 2000.
- Univariate and multivariate analyses were performed on patient and cyst characteristics to identify independent predictors of frank IBR.
Main Results:
- Frank IBR was associated with older age, male gender, longer symptom duration, larger cyst size, and higher incidence of solitary, multivesicular, left lobar, and infected cysts.
- Multivariate analysis confirmed that cyst size (≥10 cm), infection, multivesicular content, solitary nature, left lobe location, and prolonged symptoms are independent predictors of frank IBR.
Conclusions:
- Patients with specific HHC characteristics (large, multivesicular, solitary, left lobar, or infected) and prolonged symptoms face an elevated risk of frank IBR.
- Early surgical intervention is recommended for patients identified as high-risk for frank IBR.
Background/Aims:
Frank intrabiliary rupture (IBR) is a serious complication that occurs in 3-17% of patients. The aim of this study was to identify independent predictors of frank IBR of hepatic hydatid cysts (HHC).
Methodology:
Some 741 patients with HHC underwent surgery for HHC between 1965 and 2000. Patient and cyst characteristics were subjected to univariate and multivariate analysis to identify independent predictors of frank IBR.
Results:
Frank IBR was associated with significantly older age (median, 41 vs. 37 years,p =0.025), more male subjects (40% vs. 32%, p = 0.024), longer duration of symptoms (16 vs. 6 months, p < 0.001), larger cysts (median, 12 vs. 9cm, p < 0.001) and higher incidence of solitary (86% vs. 62%, p < 0.001), multivesicular (89% vs. 39%, p < 0.001), left lobar (38% vs. 13%, p < 0.001) and infected cysts (78% vs. 24%, p < 0.001). Multivariate analysis identified cyst size (> or =10 cm), cyst infection, multivesicular content, solitary cysts and location in the left lobe of liver as well as long duration of symptoms as independent predictors of frank IBR.
Conclusions:
Patients with large (> or =10 cm), multivesicular, solitary, left lobar or infected HHC as well as those with prolonged history are at increased risk of frank IBR and should be offered early surgery.
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