Biliary complications after hydatid liver surgery: incidence and risk factors

Abstract

The aims of this study were to determine the incidence and risk factors of biliary leakage and biliary fistulae after hydatid liver surgery and to suggest preventive precautions. From January 1999 to June 2000, 70 cysts were examined from 54 patients who were operated on for hydatid liver disease. Age, sex, primary or recurrent disease, liver function tests, number, location, content, radiological type, and diameter and cavity management techniques were examined with univariate and multivariate analyses for biliary complications. Biliary leakage occurred in 14 cysts (26%) from the patients. Purulent and/or bilious cyst content (61.9% vs. 2.0%; P = 0.022), male gender (40.9% vs. 10.4%; P = 0.038), and pre-operative raised alkaline phosphatase and gamma glutamyl transferase levels (34.6% vs. 11.4%; P = 0.047) were found as independent risk factors for post-operative biliary leakage. Nine instances of biliary leakage (16.7%) closed spontaneously within seven days. The remaining five instances of biliary leakage (9.3%) persisted for more than 10 days and were accepted as biliary fistulae. Stepwise logistic regression identified cyst content was the only risk factor for biliary fistulae (19% vs. 2%; P = 0.036). Described risk factors for post-operative biliary complications after hydatid liver surgery may be the guidelines for additional pre-operative or intra-operative radiological interventions of the biliary tract and for preventive procedures such as surgical biliary drainage.