title: Treatment of hydatid bronchobiliary fistulas: 30 years of experience.
abstract: BACKGROUND
  Bronchobiliary fistula (BBF) is an uncommon but severe complication of hydatid disease of the liver. Operation is considered the treatment of choice but the most appropriate operation is uncertain. The aim of this study was to evaluate the early and long-term outcomes following different surgical procedures.
  
  
  METHODS
  A retrospective evaluation of 31 patients with BBF was performed. Surgical access consisted of laparotomy, thoracotomy or a thoracoabdominal (TA) incision. Surgical procedures for the treatment of the cyst were classified as conservative or radical.
  
  
  RESULTS
  Radical treatment including lung resection and pericystectomy was performed in all patients in whom the surgical exposure was obtained by either thoracotomy or TA. Of the patients treated by laparotomy, two had a pericystectomy, and four had drainage of the cyst. There were two deaths among the seven thoracotomy patients and one among the 18 TA patients. Pleural effusion was observed in six of the TA, two of the thoracotomy, and three of the laparotomy patients. Biliary fistula occurred in two of the five thoracotomy patients surviving operation and in two laparotomy patients (2/6). Progression of the lung disease was observed in four laparotomy patients and in one thoracotomy patient.
  
  
  CONCLUSIONS
  The better outcome achieved in TA patients is the result of the simultaneous radical treatment of all the pathological aspects of BBF.
authors.affiliation: First Department of Surgery, University of Rome La Sapienza Medical School, Rome, Italy. adriano.tocchi@uniroma1.it
authors.forename: Adriano
authors.initials: A
authors.lastname: Tocchi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Mazzoni
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Miccini
authors.forename: Andrea
authors.initials: A
authors.lastname: Drumo
authors.forename: Diletta
authors.initials: D
authors.lastname: Cassini
authors.forename: Lidia
authors.initials: L
authors.lastname: Colace
authors.forename: Sandro
authors.initials: S
authors.lastname: Tagliacozzo
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D001658:Biliary Fistula / Q000469:parasitology*; D001983:Bronchial Fistula / Q000469:parasitology*; D004322:Drainage; D004444:Echinococcosis, Hepatic / Q000150:complications* / Q000601:surgery*; D004445:Echinococcosis, Pulmonary / Q000150:complications* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013908:Thoracotomy / Q000401:mortality; D016896:Treatment Outcome