Our surgical experince on the liver cyst hydatid and factors effecting on morbidity

IntroductionLiver hydatid cyst is a zoonotic disease caused by the cestods of Echinoccosis granulosus larvae. Nowadays, the most valid treatment of hydatid cyst is stil surgery. The most common complication of the disease is opening of the cyst to the biliary tract and led to prolonged duration of hospital stay. In this study, we aimed to investigate the relation between cyst location, size, preoperative laboratory values and presence of intracavitary bile duct, and also the effects of surgical procedures on complications and the duration of hospital stay.Patients and MethodBetween March 2005 and January 2010, 100 patients who underwent surgery with the diagnosis of hydatid cyst in our department were investigated retrospectively. Age, gender, cyst number, cyst location and size, stage of disease, jaundice history, preoperative laboratory values, surgical procedures, presence of intracavitary bile duct, postoperative complications and duration of hospital stay were recorded.Results63 (63 %) patients were female and 37 (37 %) patients were male. The average age was 35.6 years. Abdominal pain was present in 95 patients. 12 patients had jaundice and 18 patients had a palpable mass. The largest cyst diameter was 30 cm and the smallest one was 4 cm. 134 cysts were determined in 100 patients. Extrahepatic localized hydatid cysts in the abdomen were present in nine patients. Preoperative ERCP was performed to 13 patients because of cholangitis and obstructive jaundice. Cyst of the right lobe in 64 patients, the left lobe cyst in 17 patients, both the right and left lobe cyst in 17 patients, caudate lobe cyst in one patient and both caudate lobe and right lobe cyst in one patient were detremined. While two patients were operated on urgently because of perforation, the other patients were operated electively. Partial cystectomy + drainage + capitonnage was applied to 45 patients, partial cystectomy + drainage applied to 32 patients and partial cysterctomy+drainage+omental patch was applied to 11 patients. Seven patients were underwent laparoscopic cyst drainage and total cyst cyst excision was applied to five patients who had peripheral cyst. Intraoperatively, bile duct associated with cyst cavitary in 48 patients was found. T-tube was applied to 15 patients because of main bilary duct dilatation and the relationship with cyst and biliary duct. The avarage cyst size in the patients who had a cyst associated with bile duct was 11.8 cm and in the other patients was 8.6 cm. Preoperative AST, ALP and GGT values were 75.19 U/L, 162 U/L, 196 U/L in the patients who had biliary duct associated hydatid cyst and 69.70 U/L, 124 U/L and 114 U/L in the others, respectively. Complications were developed in 43% of patients. The most common complications were biliary fistula and cavitary infection. The biliary fistula was closed spontaneously in nine patients and endoscopic sphincterectomy was applied to the other nine patients. Surgical procedure was performed to a patient with the diagnosis of intestinal fistula associated with biliary fistula. The rate of major complication was 50% in the group with biliary duct associated cysts and 15.4% in the other group (p<0.001). The duration of hospital stay was 17.48 days in the group with biliary duct associated cysts and 8.46 days in the other group (p<0.001).ConclusionIn the patients who have large cyst diameter or high values of AST, ALP and GGT levels, the risk of the presence of a cyst associated with bilary duct was increased. Major complication rates and the duration of hospital stay were increased significantly in patients with biliary duct associated cysts. Location of the cyst, stage of the disease and surgical technique had no effect on the duration of hospital stay and complications.