Karaciğer Hidatik Kist Ameliyatı Sonrası Biliyer Fistül Gelişiminde Risk Faktörlerinin Retrospektif Analizi

Abstract

Giriş ve Amaç: Kistik ekinokokkozis (CE), Echinococcus granulosus larvalarının neden olduğu paraziter bir hastalıktır. CE benign karakterde bir hastalık olmasına rağmen komplike kistler varlığında morbiditesi yüksektir. En önemli komplikasyonlar safra yollarının fistülizasyonu ve intraperitoneal kist rüptürleridir. Materyal ve Metod: 2011-2021 yılları arasında Atatürk Üniversitesi Araştırma Hastanesi'nde CE nedeniyle ameliyat edilen hastalar geriye dönük olarak incelendi. Ameliyat edilen tüm hastaların demografik bilgileri, CE lokalizasyonu, kist boyutu, CE sınıflandırması, cerrahi teknikler ve hastanede kalış süreleri kaydedildi. Tüm veri türlerinin kategorik değişken üzerindeki etkisi ikili lojistik regresyon kullanılarak analiz edildi. Bulgular: Hastaların 299'u (%60,2) kadın, 198'i (%39,8) erkekti. Safra fistülü olan ve olmayan grupta yaş ortalamaları sırasıyla 41 ± 15.48 ve 41 ± 15.36 idi. İki grup arasında ortalama kist boyutlarında anlamlı bir fark bulduk. WHO sınıflamasına göre kist yerleşimi ve kist tipi, kistobiliyer bağlantı üzerinde istatistiksel olarak anlamlı bir etkiye sahipti (sırasıyla p: 0.00, p: 0.00. Kist tiplerine göre analiz, CE 1, CE2, CE3A ve CE3B kistlerinin biliyer üzerinde istatistiksel olarak anlamlı derecede etkili olduğunu gösterdi. fistül oluşumu CE 1 tipi kistler diğer kist tiplerine göre daha etkiliydi. CE 2, CE3A ve CE 3B kistleri CE1'e göre daha az etkiliydi. Sonuç: Sol lob yerleşimli karaciğer kist hidatiklerinde ve CE1 kistlerinde safra kaçağı riski daha fazladır. Büyük kistlerde safra kaçağı görülme sıklığı artar. Anahtar kelimeler: Kistik ekinokokkozis, Safra fistülü, Kisto biliyer fistül

Keywords

• Kistik Ekinokokkozis
• Safra fistülü
• Kistobiliyer bağlantı

Retrospectıve Analysis Of Risk Factors In The Development Of Biliary Fistula After Liver Hydatid Cyst Surgery

Abstract

Abstract Background: Cystic echinococcosis (CE) of the liver is a parasitic disease caused by the larvae of Echinococcus granulosus. Although CE is a disease with benign characteristics, its morbidity is high in the presence of complicated cysts. The most important complications are fistulization of the biliary tract and intraperitoneal cyst ruptures Material Methods: Patients who underwent surgery for CE in Atatürk University Research Hospital between 2011 and 2021 were analyzed retrospectively. Demographic information, CE localization, cyst size, CE classification, surgical techniques and hospitalization time of all operated patients were recorded. The effect of all data types on the categorical variable was analyzed using binary logistic regression. Results: Of the patients, 299 (60.2%) were female, and 198 (39.8%) were male. The mean age was 41 ± 15.48 and 41 ± 15.36 years in the group with and without bile fistula, respectively. We found a significant difference in mean cyst sizes between the two groups. Cyst location and cyst type according to WHO classification had a statistically significant effect on the cysto biliary communication (p: 0.00, p: 0.00, respectively. Analysis by cyst types showed that CE 1, CE2, CE3A, and CE3B cysts were statistically significantly effective on biliary fistula formation. CE 1 type cysts were more effective than other cyst types. CE 2, CE3A, and CE 3B cysts were less effective than CE1 Conclusion: The risk of bile leakage is higher in hepatic hydatid cysts located in the left lobe and in CE1 cysts. The incidence of bile leakage increases in large cysts.

Keywords

• Cystic echinococcosis
• Bile Fistula
• Cysto biliary communication

References

1. 1. Lightowlers, M.W. (2006) Vaccines against cysticercosis and hydatidosis: Foundations in taeniid cestode immunology. Parasitology International, 55 (SUPPL.), S39–S43.
2. 2. Shaikh O, Gaur NK, Vijayakumar C, Kumbhar U, Kalayarasan R. Hepatic Hydatid Cyst With Cystobiliary Communication and Cystoduodenal Fistula. Cureus. 2021 Aug 26;13(8):e17473. doi: 10.7759/cureus.17473. PMID: 34603866; PMCID: PMC8475944.
3. 3. Atahan, K., Küpeli, H., Deniz, M., Gür, S., Çökmez, A., and Tarcan, E. (2011) Can Occult Cystobiliary Fistulas in Hepatic Hydatid Disease Be Predicted Before Surgery? International Journal of. Medical Science 8 (4).
4. 4. Galati, G., Sterpetti, A. v., Caputo, M., Adduci, M., Lucandri, G., Brozzetti, S., Bolognese, A., and Cavallaro, A. (2006) Endoscopic retrograde cholangiography for intrabiliary rupture of hydatid cyst. American Journal of Surgery, 191 (2), 206–210.
5. 5. Shalayiadang P, Jiang T, Yimiti Y, Ran B, Aini A, Zhang R, Guo Q, Ahan A, Abulizi A, Wen H, Shao Y, Aji T. Double versus single T-tube drainage for frank cystobiliary communication in patients with hepatic cystic echinococcosis: a retrospective cohort study with median 11 years follow-up. BMC Surg. 2021 Jan 6;21(1):12.
6. 6. Al-Saeedi M, Khajeh E, Hoffmann K, Ghamarnejad O, Stojkovic M, Weber TF, Golriz M, Strobel O, Junghanss T, Büchler MW, Mehrabi A. Standardized endocystectomy technique for surgical treatment of uncomplicated hepatic cystic echinococcosis. PLoS Neglected Tropical Disease, 2019 Jun 21;13(6):e0007516.
7. 7. Pang, Q., Jin, H., Man, Z., Wang, Y., Yang, S., Li, Z., Lu, Y., Liu, H., and Zhou, L. (2018) Radical versus conservative surgical treatment of liver hydatid cysts: a meta-analysis. Frontiers of Medicine, 12 (3), 350–359.
8. 8. Toumi, O., Ammar, H., Gupta, R., ben Jabra, S., Hamida, B., Noomen, F., Zouari, K., and Golli, M. (2019) Management of liver hydatid cyst with cystobiliary communication and acute cholangitis: a 27-year experience. European Journal of Trauma and Emergency Surgery, 45 (6), 1115–1119.

9. 9. Macpherson, C.N.L., Vuitton, D.A., Gharbi, H.A., Caremani, M., Frider, B., Brunettii, E., Perdomo, R., Schantz, P.M., Felice, C., Teggi, A., da Silva, A., Pawlowski, Z.S., Todorov, T., Pelaez, V., Salama, H., Tinelli, M., Guarnera, E., Lapini, L., Akhan, O., and Hao, W. (2003) International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Tropica, 85 (2), 253–261.
10. 10. Wang, Z., Xu, J., Pang, M., Guo, B., Xu, X., Wang, H., Zhou, Y., Ren, L., Zhang, L., Ma, J., and Fan, H. Nomogram Analysis and Internal Validation to Predict the Risk of Cystobiliary Communication in Patients Undergoing Hydatid Liver Cyst Surgery. World Journal of Surgery, 44.
11. 11. HANKINS, J.R. (1963) MANAGEMENT OF COMPLICATED HEPATIC HYDATID CYSTS. Annals of Surgery, 158 (6), 1020–1034.
12. 12. Kara, S., Korkut, E., Aksungur, N., Altundas, N., Ozturk, G., Yildiz, M., and Yeni, M. (2022) Predictive Ability of Prognostic Markers in Cystic Echinococcosis with Bile Leakage. International Journal of Echinococcoses, 2022;1(2):38-45
13. 13. El-Gendi, A.M., El-Shafei, M., and Bedewy, E. (2018) The Role of Prophylactic Endoscopic Sphincterotomy for Prevention of Postoperative Bile Leak in Hydatid Liver Disease: A Randomized Controlled Study. Journal of Laparoendoscopic and Advanced Surgical Techniques, 28(8),990–996.doi: 0.1089/lap.2017.0674.
14. 14. Deo, K.B., Kumar, R., Tiwari, G., Kumar, H., Verma, G.R., and Singh, H. (2020) Surgical management of hepatic hydatid cysts-conservative versus radical surgery. HPB (Oxford), 22 (10), 1457–1462.
15. 15. Farhat, W., Ammar, H., Rguez, A., Harrabi, F., Said, M.A., Ghabry, L., Gupta, R., ben cheikh, A., Ghali, H., ben Rajeb, M., ben Mabrouk, M., and ben Ali, A. (2022) Radical versus conservative surgical treatment of liver hydatid cysts: A paired comparison analysis. American Journal of Surgery, 224 (1 Pt A), 190–195.
16. 16. Sokouti, M., Sadeghi, R., Pashazadeh, S., Hasan Abadi, S.E., Sokouti, M., Ghojazadeh, M., and Sokouti, B. (2019) A systematic review and meta-analysis on the treatment of liver hydatid cyst using meta-MUMS tool: comparing PAIR and laparoscopic procedures. Archive of Medical Science, 15 (2), 284–308.
17. 17. Reddy, A.D., and Thota, A. (2018) Cystobiliary communication (CBC) in hepatic hydatidosis: predictors, management and outcome. International Surgery Journal, 6 (1), 61–65.
18. 18. Demircan, O., Baymus, M., Seydaoglu, G., Akinoglu, A., and Sakman, G. (2006) Occult cystobiliary communication presenting as postoperative biliary leakage after hydatid liver surgery: Are there significant preoperative clinical predictors? Canadian Journal of Surgery, 49 (3), 177.
19. 19. Atli, M., Kama, N.A., Yuksek, Y.N., Doganay, M., Gozalan, U., Kologlu, M., and Daglar, G. (2001) Intrabiliary rupture of a hepatic hydatid cyst: associated clinical factors and proper management. Archive of Surgery, 136 (11), 1249–1255.
20. 20. Kayaalp, C., Bzeizi, K., Demirbag, A.E., and Akoglu, M. (2002) Biliary complications after hydatid liver surgery: Incidence and risk factors. Journal of Gastrointestinal Surgery, 6 (5), 706–712.