Bile leaks following surgery for hepatic hydatid disease.
BACKGROUND
Conservative surgery (cyst evacuation and partial pericystectomy) for hydatid cysts of the liver is known to be safe but is often associated with bile leak and its sequelae.


METHODS
Case records of 86 patients undergoing surgery for hydatid cysts of the liver at a tertiary-care center in northern India over a 14-year period were reviewed retrospectively.


RESULTS
Sixteen (18%) patients had jaundice and 36 (42%) had a cyst-biliary communication detected at surgery. Biliary complications developed in 14 (16%) patients. Bile leaks and bilio-cutaneous fistulae were observed in 11 (13%) patients; the fistula output was low (< 300 mL/day) in 8 of these. Three patients had localized intra-abdominal bile collections; all 3 underwent percutaneous drainage of biloma (subsequent laparotomy and lavage was required in one patient due to failure of percutaneous drainage), producing controlled low-output bilio-cutaneous fistulae in all. All low-output fistulae closed spontaneously after a mean duration of 4 weeks. Patients with high-output fistulae underwent endoscopic intervention (stenting/naso-biliary drainage), resulting in the conversion of these fistulae to low-output category and eventual closure after a mean duration of 7.5 weeks.


CONCLUSIONS
Postoperative bile leaks lead to significant morbidity after surgical management of hydatid cysts of liver. A majority of them resolve spontaneously. Biliary drainage (endoscopic or surgical) hastens the closure of these bilio-cutaneous fistulae.
Agarwal
Shaleen
S
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.
Sikora
Sadiq Saleem
SS
Kumar
Ashok
A
Saxena
Rajan
R
Kapoor
Vinay Kumar
VK
D000293:Adolescent; D000328:Adult; D001658:Biliary Fistula / Q000209:etiology*; D002648:Child; D019299:Decompression, Surgical; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004322:Drainage; D004444:Echinococcosis, Hepatic / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies