Can biliary-cyst communication be predicted before surgery for hepatic hydatid disease: does size matter?
BACKGROUND
The aim of this study was to determine if there is any predictive factor indicating the risk of bile leakage before surgery for hepatic hydatid disease in clinically asymptomatic patients.


METHODS
The data of 116 patients who underwent surgery for hepatic hydatid disease were reviewed retrospectively. There were 43 men (37%) and 73 women (63%) with a mean age of 45 +/- 15 years. Because of high preoperative serum bilirubin and liver function test levels, 12 patients were excluded from the study. These patients underwent preoperative endoscopic retrograde cholangiopancreatography. In addition, 2 medically treated patients were excluded from the study. The following variables were analyzed as potential predictors of biliary-cyst communication: age, sex, physical examination findings, leukocyte count, liver function test results, and ultrasonographic cyst features (type, diameter, number, and localization).


RESULTS
Bile leakage was detected in 24 out of 102 patients. There were no differences in age, sex, cyst type, alkaline phosphatase level, gamma-glutamyl transpeptidase level, alanine aminotransferase level, aspartate aminotransferase level, bilirubin level, and number of cysts and cyst locations between the patients with and without bile leakage. The mean cyst size in patients with biliary leakage was 10.2 cm as compared with 6.1 cm in patients with no biliary leakage (P < .05). When the cut-off value of cyst diameter was accepted as 7.5 cm, the specificity and sensitivity for biliary-cyst communication were 73% and 79%, respectively.


CONCLUSIONS
These data suggest that cyst diameter is an independent factor that is associated with a high risk of biliary-cyst communication in clinically asymptomatic patients. Preoperative endoscopic retrograde cholangiopancreatography should be performed in these asymptomatic patients to reduce the incidence of postoperative complications.
Fifth Department of Surgery, Ankara Numune Training and Research Hospital, Cagri Sokak 26/4, Aydinlikevler/Ankara, 06130, Ankara, Turkey.
Mehmet
M
Kilic
Omer
O
Yoldas
Mahmut
M
Koc
Mehmet
M
Keskek
Nazile
N
Karakose
Tamer
T
Ertan
Erdal
E
Gocmen
Mesut
M
Tez
D000328:Adult; D001646:Bile; D001658:Biliary Fistula / Q000175:diagnosis* / Q000209:etiology; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004444:Echinococcosis, Hepatic / Q000601:surgery*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome