A clinical study for preoperative prediction of cyst-biliary communications in hepatic hydatid cyst disease

ABSTRACT

Background: Cyst-biliary communication with hepatic hydatid cyst disease is responsible for postoperative bile leakage after surgical management. This study aims to detect various predictors of cyst-biliary communication and their predictive accuracy.Methods: This study was done in the patients of hydatid cysts who underwent surgical management for hydatid disease of the liver. Various factors were studied and their accuracy for preoperative prediction of cyst-biliary communication analyzed.Results: There were 38 (22 males, 16 females) patients with hepatic hydatid cysts with a mean age of 38.7±15.4 years. Cyst-biliary communications were detected in 12 patients (31.6%). Independent strong predictors were tenderness in right hypochondrium (p=0.035), total leucocyte count (TLC)>12,000/mm3 (p=0.0017),  eosinophil count >5 × 108/l (p=0.0086), red blood cell distribution width (RDW) >15% (p=0.014), segment IV,V,VII involvement and cyst size >10 cms (p=0.01) on multivariate analysis.Conclusions: Cyst-biliary communication is more common in patients presenting with tenderness in right hypochondrium, large cyst size, location in the central segments of liver close to biliary confluence, and with high values of TLC, Eosinophil count and RDW. The predictors demonstrated in this study should allow the likelihood of cyst-biliary communication to be determined preoperatively and, thus, indicate the need for additional procedures during operations to prevent the complications of biliary leakage.