title: Changing paradigms in the surgical management of cystic liver hydatidosis improve the postoperative outcomes.
abstract: OBJECTIVE
  Our aim was to propose and examine the outcomes of a comprehensive strategy for the management of cystic liver hydatidosis (CLH) based on extensive intraoperative assessments and optimal management of cystobiliary communications.
  
  
  BACKGROUND
  Although operative intervention remains the preferred treatment for CLH, and the presence of a cystobiliary communication remains a well-established predictive factor for postoperative complications, no internationally accepted management strategy integrates the specific management of cystobiliary communication into the choice of surgical approach.
  
  
  METHODS
  Early postoperative outcomes were compared before (1990-2004; P1 group; n = 664) and after (2005-2013; P2 group; n = 156) the implementation of a CLH surgical management strategy for CLH in our overall group of patients in subgroups selected by risk factors (as determined by multivariate analysis), and in 2 propensity score-matched groups.
  
  
  RESULTS
  Specific complications related to the hepatic procedure (intraabdominal complications) were independently associated with the presence of ≥ 3 cysts (P = .013), a fibrotic pericyst (P = .005), a cystobiliary communication (P < .001), and the P1 treatment period (P = .002). Between P1 and P2 groups, the rate of specific complications decreased in the overall group of patients with CLH (18.3% vs 4.5%; P < .001). The rate also decreased in risk factor-based subgroups: patients with ≥ 3 cysts (31.0% vs 4.0%; P = .005), a fibrotic pericyst (23.1% vs 9.2%; P = .011), and a cystobiliary communication (33.0% vs 13.2%; P = .006). After propensity score matching among 123 well-balanced matched pairs of patients, the overall complication rate, specific hepatic surgery-related complication rate, and median duration of hospital stay decreased between the P1 and P2 groups: 23.6% vs 12.2% (P = .02), 21.1% vs 4.9% (P < .001), and 7 vs 5 days (P < .001), respectively.
  
  
  CONCLUSIONS
  Implementation of a CLH surgical management strategy based on specific intraoperative assessment and optimal management of cystobiliary communications improved early postoperative outcomes.
authors.affiliation: Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco.
authors.forename: Amine
authors.initials: A
authors.lastname: Benkabbou
authors.affiliation: Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco. Electronic address: souadka@gmail.com.
authors.forename: Amine
authors.initials: A
authors.lastname: Souadka
authors.affiliation: Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco.
authors.forename: Badr
authors.initials: B
authors.lastname: Serji
authors.affiliation: Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco.
authors.forename: Hajar
authors.initials: H
authors.lastname: Hachim
authors.affiliation: Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco.
authors.forename: Raouf
authors.initials: R
authors.lastname: Mohsine
authors.affiliation: Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco.
authors.forename: Lahsen
authors.initials: L
authors.lastname: Ifrine
authors.affiliation: Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco.
authors.forename: Abdelkader
authors.initials: A
authors.lastname: Belkouchi
authors.affiliation: Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco.
authors.forename: Hadj Omar
authors.initials: HO
authors.lastname: El Malki
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D004444:Echinococcosis, Hepatic / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000592:standards; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome