title: Subadventitial cystectomy in the management of biliary fistula with liver hydatid disease.
abstract: Biliary fistulas are the most common morbidity (8.2-26%) following hydatid liver surgery. The aim of this study was to evaluate the results of subadventitial cystectomy in the treatment of liver hydatid cyst associated with a biliocystic fistula. The medical records of 153 patients who underwent subadventitial cystectomy for a liver hydatid cyst between January 2006 and December 2010 were retrospectively reviewed. Cysts were located in the right lobe anterior segment 37 (24.2%) patients, right lobe posterior segment 59 (38.6%) patients, the left lobe in 26 (17.0%) patients, and both lobes in 6 (3.9%) patients. The surgical procedures performed were closed (non-incised) subadventitial total cystectomy in 74 patients (48.4%), open (incised) subadventitial total cystectomy in 30 patients (19.6%), and subadventitial subtotal cystectomy in 49 patients (32.0%). Biliocystic communication was found in 52 patients (34.0%), and 21 patients (13.7%) were treated with T-tube drainage. Two patients had performed biliodigestive anastomosis. Biliary fistula was detected in 9 patients after subtotal subadventitial cystectomy. Biliary fistulas closed spontaneously within 10 days and 61 days respectively and the amount of drainage varying between 50 and 400ml after the procedure. Postoperative complication and recurrence rates were 19.0% and 0.7%, respectively. The mortality rate was 0%. Subadventitial cystectomy should be the surgical treatment of choice for this disease because of its feasibility and low rates of recurrence, complications of the residual cavity, and incidence of associated biliary fistula.
authors: Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine Shihezi University, Shihezi City, Xinjiang Province 832008, China.
authors: Hailong
authors: H
authors: Lv
authors: Department of Histology and Embryology, Medical College, Shihezi University, Shihezi City, Xinjiang Province, China. Electronic address: yufengjiang03@126.com.
authors: Yufeng
authors: Y
authors: Jiang
authors: Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine Shihezi University, Shihezi City, Xinjiang Province 832008, China.
authors: Xinyu
authors: X
authors: Peng
authors: Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine Shihezi University, Shihezi City, Xinjiang Province 832008, China.
authors: Shijie
authors: S
authors: Zhang
authors: Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine Shihezi University, Shihezi City, Xinjiang Province 832008, China.
authors: Xiangwei
authors: X
authors: Wu
authors: Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine Shihezi University, Shihezi City, Xinjiang Province 832008, China.
authors: Hongqiang
authors: H
authors: Yang
authors: Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine Shihezi University, Shihezi City, Xinjiang Province 832008, China.
authors: Hongwei
authors: H
authors: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D063194:Adventitia / Q000601:surgery*; D000368:Aged; D001658:Biliary Fistula / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods*; D019468:Disease Management; D004444:Echinococcosis, Hepatic / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
keywords: Biliary fistula; Hydatid disease; Liver; Surgery