Postoperative Bile Leak in Liver Hydatid Cyst: When to Intervene?

Postoperative bile leak (POBL), a major concern in liver hydatid cyst (LHC) surgery, can be managed either conservatively or by endoscopic therapy. There is a need for some objective parameters to guide endoscopic therapy for POBL in LHC surgery.

This study was carried out in the Department of Surgical Gastroenterology in a tertiary care centre in Northern India.

A total of 116 surgically managed patients for LHC were analysed retrospectively using regression analysis and receiver operating characteristics (ROC) curves to identify factors predicting endoscopic therapy in POBL.

POBL was found in 31.8% (37 of 116) of patients. Most of the patients had POBL <300 mL/day (67.6%). Patients with POBL experienced more morbidity (P = 0.0001) in comparison with patients without POBL. Out of 37 patients with POBL, 22 (59.5%) were managed conservatively, and 15 (40.5%) were managed with endoscopic retrograde cholangiopancreatography. Patients with POBL managed with endoscopic therapy had higher daily bile output (P = 0.055), longer time to removal of drain (P = 0.002), and longer postoperative stay (P < 0.0001) when compared with conservatively managed patients. Male gender [Odds ratio (OR) = 5.10, p=0.026], POBL >300 mL/day (OR = 5.143, P = 0.031), POBL >14 days (OR = 6.800, P = 0.010), and hospital stay >14 days (OR = 11.42, P = 0.007) predicted the need for endoscopic therapy in managing POBL. On ROC curve analysis, daily POBL >210 mL [area under the curve (AUC) = 0.773, P = 0.005] and POBL for >12.5 days (AUC = 0.826, P = 0.001) were cut-off values for the need for endoscopic therapy for managing POBL.

POBL in LHC surgery is a serious problem. Male patients with daily POBL >300 mL, bile leak >14 days, and hospital stay >14 days had higher chances for the need for endoscopic therapy.