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Predictors of cystobiliary communication in patients undergoing surgery for hepatic hydatid cysts
İbrahim Doğan1, Berk Topaloğlu2, Ezgi Sönmez2
1Department of General Surgery, University of Health Sciences Van Training & Research Hospital, Van, Turkey. dogan_203@hotmail.com.
Insights
Cystobiliary communication (CBC) in hepatic hydatid disease is predicted by cyst size and direct bilirubin levels. Occult CBC requires vigilant postoperative monitoring due to potential bile leaks.
Area of Science:
- Hepatobiliary Surgery
- Parasitic Diseases
- Surgical Complications
Background:
- Cystobiliary communication (CBC) is a frequent complication of hepatic hydatid cysts.
- It complicates surgery and increases postoperative morbidity.
- Preoperative prediction and intraoperative detection of occult CBC are challenging.
Purpose of the Study:
- To identify independent predictors of cystobiliary communication (CBC) in hepatic hydatid disease.
- To evaluate the effectiveness of intraoperative detection methods for occult CBC.
- To compare outcomes between frank and occult CBC.
Main Methods:
- Retrospective analysis of 106 patients with hepatic hydatid disease.
- Classification into CBC or non-CBC groups based on intraoperative findings.
- Multivariate logistic regression and ROC analysis to identify predictors and optimal cut-offs.
Main Results:
- CBC occurred in 42% of patients (16% frank, 26% occult).
- Independent predictors identified were cyst size (≥8.85 cm) and direct bilirubin (≥0.7 mg/dL).
- Occult CBC led to postoperative bile fistulas in 25% despite intraoperative tests.
Conclusions:
- Cyst size and direct bilirubin are key predictors of CBC.
- Intraoperative tests are insufficient for excluding occult CBC.
- Postoperative monitoring and management are crucial for high-risk patients.
Abstract:
Cystobiliary communication (CBC) is a common complication of hepatic hydatid cysts, increasing surgical complexity and postoperative morbidity. Reliable preoperative prediction and intraoperative detection of occult CBC remain challenging. We retrospectively analyzed 106 patients undergoing surgery for hepatic hydatid disease. Patients were classified as CBC or non-CBC based on intraoperative findings. Clinical, laboratory, radiologic, and operative variables were evaluated. Multivariate logistic regression identified independent predictors, and Receiver Operating Characteristic (ROC) analysis determined optimal cut-offs. Subgroup analysis compared occult and frank CBC. CBC occurred in 42% of patients (16% frank, 26% occult). Multivariate analysis revealed cyst size (OR 1.29; 95% CI 1.07-1.56; p = 0.007) and direct bilirubin (OR 16.35; 95% CI 2.60-102.3; p = 0.003) as independent predictors. ROC analysis suggested thresholds of ≥ 8.85 cm for cyst size and ≥ 0.7 mg/dL for direct bilirubin. Occult CBC accounted for 26% of cases; despite intraoperative provocation tests and saline/dye injection, 25% developed high-output postoperative bile fistula, some requiring ERCP. Subgroup analysis indicated that frank CBC was associated with larger cysts, higher cholangitis rates, and more frequent intrahepatic bile duct dilatation, but postoperative outcomes were comparable. Cyst size and direct bilirubin are independently associated with CBC. Intraoperative provocation tests cannot fully exclude occult communication; vigilant postoperative monitoring and proactive biliary management are essential for high-risk patients.
