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Retrospective analysis of risk factors for development of biliary fistula after liver cyst hydatid surgery

Yıl 2019, , 45 - 48, 15.03.2019
https://doi.org/10.25000/acem.531385

Öz

Aim: Hepatic
hydatidosis is common parasitosis in Turkey and caused by Echinococcus granulosus.
Biliary fistula is the most common complication after liver hydatid cyst
surgery. The aim of this study was to investigate an appropriate treatment
strategy for patients whose biliary fistula might develop, by revealing
variables that affect biliary fistula.

Methods: A total of
118 patients who underwent liver hydatid cyst surgery were included in this
study. The following variables were analyzed between patients with biliary
fistula (group 2) and without fistula (group 1): Age, gender, hematologic and
liver function tests, and features of the cysts (type, cyst size, number, and
localization).

Results: Cystobiliary fistula was detected in
19 (16%) of 118 patients. In-group 2, cyst size,
white blood cell,
alkaline phosphatase and g-Glutamyl transpeptidase levels were higher than
group 1 on univariate analysis (p=0.03, p=0.008, p=0.04 and p=0.001,
respectively). In the multivariate model, only cyst diameter remained as an
independent predictor (odds ratio 0.03, 95% confidence interval 0.002 to 0.06;
p=0.03) On the receiver operating characteristic curve, the 100% sensitive,
100% specific, and optimal cutoffs of the cyst diameter were 7.5 cm, 4.0 cm and14.6
cm, respectively (The area under the receiver operator characteristic curve was
0.67).







Conclusion: Preoperative cyst size is a valuable
parameter for predicting biliary fistula. Our study suggests that cyst size
greater than 7.5 cm is a risk factor for biliary fistula. 

Kaynakça

  • 1. Jenkins DJ, Romig T, Thompson RC. Emergence/re-emergence of Echinococcus spp.—a global update. Int J Parasitol. 2005;35:1205-19.
  • 2. Romig T, Dinkel A, Mackenstedt U. The present situation of echinococcosis in Europe. Parasitol Int. 2006;55:187.
  • 3. Alper A, Arioglu O, Emre A, Uras A, Okten A. Choledochoduodenostomy for intrabiliary rupture of hydatid cyst of liver. Br J Surg. 1987;74:243–5.
  • 4. Atahan K, Kupeli H, Deniz M, Gur S, Cokmez A, Tarcan E. Can occult cystobiliary fistulas in hepatic hydatid disease be predicted before surgery? Int J Med Sci. 2011;8:315-20.
  • 5. Vicente E, Meneu JC, Hervas PL, Nuno J, Quijano Y, Devesa M, et al. Management of biliary duct confluence injuries produced by hepatic hydatidosis. World J Surg. 2001;25:1264-9.
  • 6. Karabay Ö, Bostancı Ö. Biliary fistula after liver hydatid cyst surgery: Is it a predictable complication? Arch Clin Exp Med. 2018;3:186-9.
  • 7. Saylam B, Coşkun F, Demiriz B, Vural V, Çomçalı B, Tez M. A new and simple score for predicting cystobiliary fistula in patients with hepatic hydatid cysts. Surgery, 2013;153:699-704.
  • 8. Alan B, Kapan M, Teke M, Hattapoğlu S, Arıkanoglu Z. Value of cyst localization to predict cystobiliary communication in patients undergoing conservative surgery with hydatid cyst. Ther Clin Risk Manag. 2016;12:995-1001.
  • 9. Manouras A, Genetzakis M, Antonakis PT, Lagoudianakis E, Pattas M, Papadima A, et al. Endoscopic management of a relapsing hepatic hydatid cyst with intrabiliary rupture: a case report and review of the literature. Can J Gastroenterol. 2007;21:249-53.
  • 10. Erden A, Ormeci N, Fitoz S, Erden I, Tanju S, Genç Y. Intrabiliary rupture of hepatic hydatid cysts: diagnostic accuracy of MR cholangiopancreatography. AJR Am J Roentgenol. 2007;189:W84-9.
  • 11. Chautems R, Buehler LH, Gold B, Chilcott MJ, Morel P, Mentha G. Long term results after complete or incomplete surgical resection of liver hydatid disease. Swiss Med Wkly. 2003;133:258-62.
  • 12. Gharbi HA, Hassine W, Brauner MW, Dupuch K. Ultrasound examination of the hydatic liver. Radiology. 1981;139:459-63.
  • 13. Daradkeh S, Husam EM, Farah G, Sroujieh AS, Abu-Khalaf M. Predictors of morbidity and mortality in the surgical management of hydatid cyst of the liver. Langenbeck's Arch Surg. 2007;392:35-9.
  • 14. Valle-Sanz Yd Y, Lorente-Ramos RM. Sonographic and computed tomographic demonstration of hydatid cysts communicating with the biliary tree. J Clin Ultrasound. 2004;32:144–8.
  • 15. Demircan O, Baymus M, Seydaoglu G, Akinoglu A, Sakman G. Occult cystobiliary communication presenting as postop- erative biliary leakage after hydatid liver surgery: are there significant preoperative clinical predictors? Can J Surg. 2006;49:177-84.
  • 16. Yildirgan MI, Başoğlu M, Atamanalp SS, Aydinli B, Balik AA, Celebi F, Ören D. Intrabiliary rupture in liver hydatid cysts: results of 20 years’ experience. Acta Chir Belg. 2003;103:621-5.
  • 17. Frider B, Larrieu E, Odriozola M. Long-term outcome of asymptomatic liver hydatidosis. J Hepatol. 1999;30:228-31.
  • 18. Moro PL, Lopera L, Bonifacio N, Gonzales A, Gilman RH, Moro MH. Risk factors for canine echinococcosis in an endemic area of Peru. Vet Parasitol. 2005:130:99-104.
  • 19. Kilic M, Yoldas O, Koc M, Keskek M, Karakose N, Ertan T, Tez M. Can biliary-cyst communication be predicted before surgery for hepatic hydatid disease: does size matter? The Am J Surg. 2008;196:732-5.
  • 20. Agarwal S, Sikora SS, Kumar A, Saxena R, Kapoor VK.. Bile leaks following surgery for hepatic hydatid disease. Indian J Gastroenterol. 2005;24:55–8.
  • 21. Atli M, Kama NA, Yuksek YN, Doganay M, Gozalan U, Kologlu M, et al. Intrabiliary rupture of a hepatic hydatid cyst: associated clinical factors and proper management. Arch Surg. 2001;136:1249-55.
  • 22. Kayaalp C, Bzeizi K, Demirbag AE, Akoglu M. Biliary com- plications after hydatid liver surgery: incidence and risk fac- tors. J Gastrointest Surg. 2002;6:706-12.
  • 23. Unalp HR, Baydar B, Kamer E, Yilmaz Y, Issever H, Tarcan E. Asymptomatic occult cysto-biliary communication with- out bile into cavity of the liver hydatid cyst: a pitfall in conservative surgery. Int J Surg. 2009;7:387-91.

Karaciğer hidatik kist cerrahisi sonrası oluşan safra fistülünün gelişimindeki risk faktörlerinin retrospektif analizi

Yıl 2019, , 45 - 48, 15.03.2019
https://doi.org/10.25000/acem.531385

Öz

Amaç: Karaciğer hidatik
kist hastalığı Echinococcus granulosus’un neden olduğu, Türkiye’de yaygın
görülen bir parazitozdur. Karaciğer kist hidatik cerrahisi sonrası en sık
gelişen komplikasyon safra fistülüdür. Bu çalışmadaki amacımız safra fistülü
gelişimini etkileyen değişkenleri ortaya koymak ve uygun tedavi seçeneklerini
incelemektir.

Yöntemler: Bu çalışmaya
karaciğer kist hidatik cerrahisi uygulanmış olan 118 hasta dahil edildi.
Hastalar safra fistülü gelişen (grup2) ve gelişmeyen (grup1) olarak iki gruba
ayrıldı ve değişkenler analiz edildi: yaş, hematolojik ve karaciğer fonksiyon
testleri ve kistin özellikleri (tip, kist boyutu, sayısı ve yerleşim yeri).

Bulgular: 118 hastanın 19 (%16)’unda safra fistülü
saptandı. Grup 2’de kist boyutu, lökosit, alkalin fosfataz ve g-Glutamin
transpeptidaz değerleri tek değişkenli analiz sonucuna göre grup 1’den daha yüksekti
(p=0,03, p=0,008, p=0,04, p=0,001). Çok değişkenli analiz sonucuna göre; safra
fistülü gelişimine etki eden tek bağımsız değişken yalnızca kist boyutu olarak
saptandı (olasılık oranı 0.03, 95% güven aralığı 0,002-0,06; p=0,03). İşlem
karakteristik eğrisine göre, kist boyutlarının 100% duyarlılık, 100% özgüllük
ve eşik değeri, sırasıyla 7,5 cm, 4,0 cm ve 14,6 cm olarak bulundu. (Eğrinin
altındaki alan 0,67).







Sonuç: Safra fistülünün
tahmininde preoperatif kist boyutu önemli bir parametredir. Bizim çalışmamıza
göre; kist boyutunun 7,5 cm’den büyük olması safra fistülü gelişimi için bir
risk faktörüdür.

Kaynakça

  • 1. Jenkins DJ, Romig T, Thompson RC. Emergence/re-emergence of Echinococcus spp.—a global update. Int J Parasitol. 2005;35:1205-19.
  • 2. Romig T, Dinkel A, Mackenstedt U. The present situation of echinococcosis in Europe. Parasitol Int. 2006;55:187.
  • 3. Alper A, Arioglu O, Emre A, Uras A, Okten A. Choledochoduodenostomy for intrabiliary rupture of hydatid cyst of liver. Br J Surg. 1987;74:243–5.
  • 4. Atahan K, Kupeli H, Deniz M, Gur S, Cokmez A, Tarcan E. Can occult cystobiliary fistulas in hepatic hydatid disease be predicted before surgery? Int J Med Sci. 2011;8:315-20.
  • 5. Vicente E, Meneu JC, Hervas PL, Nuno J, Quijano Y, Devesa M, et al. Management of biliary duct confluence injuries produced by hepatic hydatidosis. World J Surg. 2001;25:1264-9.
  • 6. Karabay Ö, Bostancı Ö. Biliary fistula after liver hydatid cyst surgery: Is it a predictable complication? Arch Clin Exp Med. 2018;3:186-9.
  • 7. Saylam B, Coşkun F, Demiriz B, Vural V, Çomçalı B, Tez M. A new and simple score for predicting cystobiliary fistula in patients with hepatic hydatid cysts. Surgery, 2013;153:699-704.
  • 8. Alan B, Kapan M, Teke M, Hattapoğlu S, Arıkanoglu Z. Value of cyst localization to predict cystobiliary communication in patients undergoing conservative surgery with hydatid cyst. Ther Clin Risk Manag. 2016;12:995-1001.
  • 9. Manouras A, Genetzakis M, Antonakis PT, Lagoudianakis E, Pattas M, Papadima A, et al. Endoscopic management of a relapsing hepatic hydatid cyst with intrabiliary rupture: a case report and review of the literature. Can J Gastroenterol. 2007;21:249-53.
  • 10. Erden A, Ormeci N, Fitoz S, Erden I, Tanju S, Genç Y. Intrabiliary rupture of hepatic hydatid cysts: diagnostic accuracy of MR cholangiopancreatography. AJR Am J Roentgenol. 2007;189:W84-9.
  • 11. Chautems R, Buehler LH, Gold B, Chilcott MJ, Morel P, Mentha G. Long term results after complete or incomplete surgical resection of liver hydatid disease. Swiss Med Wkly. 2003;133:258-62.
  • 12. Gharbi HA, Hassine W, Brauner MW, Dupuch K. Ultrasound examination of the hydatic liver. Radiology. 1981;139:459-63.
  • 13. Daradkeh S, Husam EM, Farah G, Sroujieh AS, Abu-Khalaf M. Predictors of morbidity and mortality in the surgical management of hydatid cyst of the liver. Langenbeck's Arch Surg. 2007;392:35-9.
  • 14. Valle-Sanz Yd Y, Lorente-Ramos RM. Sonographic and computed tomographic demonstration of hydatid cysts communicating with the biliary tree. J Clin Ultrasound. 2004;32:144–8.
  • 15. Demircan O, Baymus M, Seydaoglu G, Akinoglu A, Sakman G. Occult cystobiliary communication presenting as postop- erative biliary leakage after hydatid liver surgery: are there significant preoperative clinical predictors? Can J Surg. 2006;49:177-84.
  • 16. Yildirgan MI, Başoğlu M, Atamanalp SS, Aydinli B, Balik AA, Celebi F, Ören D. Intrabiliary rupture in liver hydatid cysts: results of 20 years’ experience. Acta Chir Belg. 2003;103:621-5.
  • 17. Frider B, Larrieu E, Odriozola M. Long-term outcome of asymptomatic liver hydatidosis. J Hepatol. 1999;30:228-31.
  • 18. Moro PL, Lopera L, Bonifacio N, Gonzales A, Gilman RH, Moro MH. Risk factors for canine echinococcosis in an endemic area of Peru. Vet Parasitol. 2005:130:99-104.
  • 19. Kilic M, Yoldas O, Koc M, Keskek M, Karakose N, Ertan T, Tez M. Can biliary-cyst communication be predicted before surgery for hepatic hydatid disease: does size matter? The Am J Surg. 2008;196:732-5.
  • 20. Agarwal S, Sikora SS, Kumar A, Saxena R, Kapoor VK.. Bile leaks following surgery for hepatic hydatid disease. Indian J Gastroenterol. 2005;24:55–8.
  • 21. Atli M, Kama NA, Yuksek YN, Doganay M, Gozalan U, Kologlu M, et al. Intrabiliary rupture of a hepatic hydatid cyst: associated clinical factors and proper management. Arch Surg. 2001;136:1249-55.
  • 22. Kayaalp C, Bzeizi K, Demirbag AE, Akoglu M. Biliary com- plications after hydatid liver surgery: incidence and risk fac- tors. J Gastrointest Surg. 2002;6:706-12.
  • 23. Unalp HR, Baydar B, Kamer E, Yilmaz Y, Issever H, Tarcan E. Asymptomatic occult cysto-biliary communication with- out bile into cavity of the liver hydatid cyst: a pitfall in conservative surgery. Int J Surg. 2009;7:387-91.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Orjinal Makale
Yazarlar

Emin Köse 0000-0002-0888-2576

Nilay Tuğba Baz Bu kişi benim 0000-0001-9344-6914

Deniz Tazeoğlu 0000-0002-5947-8653

Mehmet Emin Gürbüz Bu kişi benim 0000-0002-1273-631X

Hasan Tok Bu kişi benim 0000-0003-4036-9219

Ayhan Özsoy Bu kişi benim 0000-0002-7011-3946

Servet Rüştü Karahan Bu kişi benim 0000-0003-4895-5538

Yayımlanma Tarihi 15 Mart 2019
Yayımlandığı Sayı Yıl 2019

Kaynak Göster

Vancouver Köse E, Baz NT, Tazeoğlu D, Gürbüz ME, Tok H, Özsoy A, Karahan SR. Retrospective analysis of risk factors for development of biliary fistula after liver cyst hydatid surgery. Arch Clin Exp Med. 2019;4(1):45-8.