title: Can occult cystobiliary fistulas in hepatic hydatid disease be predicted before surgery?
abstract: BACKGROUND
  Biliary fistulas because of the cystobiliary communication is the most frequent and undesirable postoperative complication of hepatic hydatid surgery. We aimed to identify the predicting factors of the occult cystobiliary communication in this study.
  
  
  METHODS
  The patients who underwent surgical treatment for hepatic hydatid disease between 2003 and 2008 were reviewed retrospectively. The patients who had jaundice history, preoperative high total bilirubin and direct bilirubin levels, dilated bile duct in preoperative radiologic imagings were not included the study. Patients were divided into two groups: group A; without postoperative biliary fistula, group B; with biliary fistula. The two groups were compared according to preoperative descriptive findings, cystic specialties, and laboratory findings.
  
  
  RESULTS
  There were 53 patients and 15 patients in groupA and groupB, respectively. The 20 (37.7%) of 53 patients were male in group A and the 10 (66.7%) patients were male in group B (p<0.05). The age, number of cysts, Garbi scores of cysts, the rate of recurrent cysts, the level of preoperative bilirubin, alkalene phosphatase, and transaminases were similar in both groups (p>0.05). GGT was significantly different between two groups (p<0.05). The cystotomy + drainage, cystotomy + omentopexy, and intracystic biliary suture rates were similar in both groups. Postoperative non biliary complications were determined in 4 (7.5%) patients in group A and 7 patients (46.7%) in group B (p<0.05). Hospital stay was longer in group B significantly (p<0.05).
  
  
  CONCLUSIONS
  In conclusion, GGT as a laboratory [corrected] test for predicting occult CBC preoperatively have been shown to be useful in the clinical practice. However, larger prospective studies are needed on this subject. Occult cysto-biliary fistulas can only be exposed during surgery when suspected by a surgeon. If occult CBC is found, the opening in the biliary system should be sutured with absorbable material, with or without cystic duct drainage. If no biliary opening is found, cystic duct drainage may be performed if preoperative factors predict the presence of CBC. As the development of external biliary fistulas increases the morbidity and the hospitalization period, novel surgical methods to prevent the development of bile fistulas are required in such patients.
authors: 1st Surgical Department, Atatürk Educational and Research Hospital, İzmir, Turkey. kemalatahan@yahoo.com.tr
authors: Kemal
authors: K
authors: Atahan
authors: Hakan
authors: H
authors: Küpeli
authors: Mehmet
authors: M
authors: Deniz
authors: Serhat
authors: S
authors: Gür
authors: Atilla
authors: A
authors: Cökmez
authors: Ercüment
authors: E
authors: Tarcan
references: J Am Coll Surg. 1996 Nov;183(5):466-70
references: 8912615
references: Radiology. 1981 May;139(2):459-63
references: 7220891
references: Can J Surg. 1996 Aug;39(4):287-92
references: 8697318
references: Can J Surg. 2006 Jun;49(3):177-84
references: 16749978
references: Surg Today. 2002;32(7):594-7
references: 12111515
references: World J Surg. 2001 Jan;25(1):28-39
references: 11213153
references: J Hepatobiliary Pancreat Surg. 1998;5(2):179-83
references: 9745085
references: J Clin Gastroenterol. 2002 Aug;35(2):160-74
references: 12172363
references: Surgery. 1984 Apr;95(4):497-500
references: 6710345
references: World J Surg. 1995 Sep-Oct;19(5):720-4; discussion 728
references: 7571669
references: Arch Surg. 1980 Jul;115(7):847-50
references: 7387376
references: Arch Surg. 1999 Feb;134(2):166-9
references: 10025457
references: Arch Surg. 2001 Nov;136(11):1249-55
references: 11695968
references: Ann Ital Chir. 1997 Sep-Oct;68(5):701-6; discussion 706-9
references: 9577048
references: Br J Surg. 1990 Jan;77(1):30-1
references: 2302509
references: Hepatogastroenterology. 2001 Jul-Aug;48(40):1094-6
references: 11490808
references: J Hepatol. 1997 Jun;26(6):1408-12
references: 9210631
references: Arch Surg. 1991 Apr;126(4):518-22; discussion 523
references: 2009069
references: Am J Surg. 2003 Feb;185(2):175-9
references: 12559452
references: HPB Surg. 1998;10(6):375-7
references: 9515235
references: Br J Surg. 1987 Apr;74(4):243-5
references: 3580792
references: World J Surg. 2002 Jun;26(6):704-8
references: 12053223
references: J Gastrointest Surg. 2002 Sep-Oct;6(5):706-12
references: 12399060
references: Surg Laparosc Endosc Percutan Tech. 2002 Jun;12(3):187-9
references: 12080262
references: Br J Surg. 1992 Nov;79(11):1182-3
references: 1467900
references: Arch Surg. 1983 Oct;118(10):1186-9
references: 6615202
references: AJR Am J Roentgenol. 1988 May;150(5):1051-3
references: 3282402
references: Arch Surg. 2002 Feb;137(2):159-63
references: 11822952
references: Ann Surg. 1963 Dec;158:1020-34
references: 14081536
references: Surg Endosc. 2002 Jun;16(6):985-8
references: 12163969
references: World J Surg. 2004 Feb;28(2):173-8
references: 14708059
references: World J Surg. 1991 Mar-Apr;15(2):254-63
references: 2031363
references: Endoscopy. 2001 Oct;33(10):858-63
references: 11571682