Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study

Tamer A A M Habeeb; Mauro Podda; Boris Tadic; Vishal G Shelat; Yaman Tokat; Mohamed Ibrahim Abo Alsaad; Abd-Elfattah Kalmoush; Mohammed Shaaban Nassar; Fawzy Metwally Mustafa; Mahmoud Hassib Morsi Badawy; Mohamed Sobhy Shaaban; Tarek Zaghloul Mohamed; Mohammed Ibrahim El Sayed Henish; Hamdi Elbelkasi; Mahmoud Abdou Yassin; Abdelshafy Mostafa; Amr Ibrahim; Waleed A-Abdelhady; Tamer Mohamed Elshahidy; Mohamed Ibrahim Mansour; Adel Mahmoud Moursi; Mohamed Abdallah Zaitoun; Ehab Shehata Abd-Allah; Ashraf Abdelmonem Elsayed; Rasha S Elsayed; Ahmed M Yehia; Amr Abdelghani; Mohamed Negm; Heba Alhussein Abo-Alella; Mostafa M Elaidy

doi:10.5662/wjm.v13.i4.272

Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study

World J Methodol. 2023 Sep 20;13(4):272-286. doi: 10.5662/wjm.v13.i4.272.

Authors

Tamer A A M Habeeb¹, Mauro Podda², Boris Tadic³, Vishal G Shelat⁴, Yaman Tokat⁵, Mohamed Ibrahim Abo Alsaad⁶, Abd-Elfattah Kalmoush⁷, Mohammed Shaaban Nassar⁷, Fawzy Metwally Mustafa⁷, Mahmoud Hassib Morsi Badawy⁷, Mohamed Sobhy Shaaban⁷, Tarek Zaghloul Mohamed⁷, Mohammed Ibrahim El Sayed Henish⁷, Hamdi Elbelkasi⁸, Mahmoud Abdou Yassin¹, Abdelshafy Mostafa¹, Amr Ibrahim¹, Waleed A-Abdelhady¹, Tamer Mohamed Elshahidy⁹, Mohamed Ibrahim Mansour¹, Adel Mahmoud Moursi¹, Mohamed Abdallah Zaitoun¹, Ehab Shehata Abd-Allah¹, Ashraf Abdelmonem Elsayed¹, Rasha S Elsayed¹, Ahmed M Yehia¹, Amr Abdelghani¹, Mohamed Negm¹, Heba Alhussein Abo-Alella¹, Mostafa M Elaidy¹

Affiliations

¹ Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt.
² Department of Surgical Science, University of Cagliari, Cagliari 09126, Italy.
³ Clinic for Digestive Surgery - First Surgical Clinic, University Clinical Centre of Serbia, Belgrade 11000, Serbia.
⁴ Department of General Surgery, Tan Tock Seng Hospital, Singapore 018971, Singapore.
⁵ Department of Liver Transplantation and Hepatobiliary Surgery, Istanbul, Turkey, International Liver Center, and Acibadem Hospital Group, Istanbul 34000, Turkey.
⁶ Department of General Surgery, Faculty of Medicine -Merit University, Sohag 82511, Egypt.
⁷ Department of General Surgery, Faculty of Medicine, Al-Azher University, Cairo 11765, Egypt.
⁸ Department of General Surgery, Mataryia Teaching Hospital, Cairo 11765, Egypt.
⁹ Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt. tameralnaimy@hotmail.com.

Abstract

Background: Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study was to identify whether occult cysto-biliary communication (CBC) can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase (ALP) levels in predicting POBF and recurrent HCD.

Aim: To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD.

Methods: From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence.

Results: There was a highly statistically significant association (P ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association (P ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively.

Conclusion: Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.

Keywords: Cysto-biliary communication; Echinococcus granulosus; Hydatid disease recurrence; Hydatid fluid analysis; Laparoscopy.