Effects of a preoperative and perioperative multidisciplinary approach for complicated liver hydatid cyst on...

To investigate effects of a preoperative and perioperative multidisciplinary approach for complicated liver hydatid cyst on postoperative outcomes.

Hospital records about 114 patients operated for liver hydatid cyst in the past ten years were retrospectively evaluated. Of 114 patients, 48 required a preoperative multidisciplinary approach (Group M) and 66 did not require it (Group NM).

In Group M, 16 patients underwent endoscopic retrograde cholangiopancreaticography (ERCP) before surgery. Twenty-six patients underwent surgery only since they were refractory to interventional radiological procedures. Six patients underwent perioperative interventional radiological procedures. Out of 26 centrally located cysts, 15 (57.6%) were found to have a communication with bile ducts and 12 (46.2%) were found to have bile fistulae, which were statistically significant when compared to peripherally located cysts (p = 0.001 and 0.03 respectively). Although five of six patients in Group M having emergency surgery underwent preoperative ERCP, they did not experience clinical improvement and therefore they also had supportive surgery.

The rate of centrally located liver hydatid cysts communicating with the bile ducts and having fistulae was higher. Preoperative ERCP has a positive effect on postoperative outcome in patients with bile fistulae and therefore, it should be kept in mind in management of liver hydatid cysts. However, ERCP may be insufficient in treating cholangitis and emergency situations. Surgery can be used as a supportive treatment when ERCP is inconclusive and when the cysts become refractory despite treatment with interventional radiology.