Surgical treatment of intrabiliary rupture of hydatid cysts of liver: comparison of choledochoduodenostomy with T-tube drainage.

BACKGROUND: Intrabiliary rupture is one of the most serious complications of liver hydatid cysts (LHC). The kind of surgery for these patients is still controversial. T-tube drainage and choledochoduodenostomy (CD) are used by most of the surgeons. But there is no comparative study in the literature. METHODS: Eighty patients with symptomatic intrabiliary rupture were treated between 1980 and 1995. All patients had jaundice. In addition to treatment of the cyst cavity, T-tube drainage of the common bile duct (CBD) was performed in 53 patients, 25 patients underwent a CD for biliary drainage and two patients were treated by a T-tube placed in the CBD without treating the cyst. The T-tube drainage and CD groups were compared in regard to morbidity, mortality, duration of the operation, rate of relaparatomy and duration of postoperative hospital stay. RESULTS: The morbidity rate was 40% (10/25) after CD and 18.1% (10/55) after T-tube drainage. Relaparatomy was necessary in 8% (2/25) and 1.8% (1/55) of patients treated with CD and T-tube drainage, respectively. T-tube drainage was performed much more rapidly than CD (p < 0.05). The length of hospital stay for both groups was the same. One patient who was treated with CD died postoperatively. CONCLUSION: Our results suggest that T-tube drainage is superior to CD for intrabiliary rupture of LHC in most cases.

Human fascioliasis.

Infestation with fasciola hepatica is not often seen in humans. Only a few cases have been reported previously, while in our clinic only three cases have been observed in 20 years. All three cases (two males aged 35 and 40 and a 45-year-old female) were operated on with the possible diagnosis of choledocholithiasis, and parasites were later incidentally discovered at operation. In recent years praziquantel has been used with a high rate of success in the medical treatment of this disease. We have also prescribed praziquantel for our last two cases in order to prevent recurrence and to kill any parasites that might still remain after the operation. In the post-operative follow-up a complete cure was observed in all cases.