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Changing paradigms in the surgical management of cystic liver hydatidosis improve the postoperative outcomes.

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Benkabbou A(1), Souadka A(2), Serji B(1), Hachim H(1), Mohsine R(1), Ifrine L(1), Belkouchi A(1), El Malki HO(1).

Author information:

(1)Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco.

(2)Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco.

Electronic address: souadka@gmail.com.

AIM OF THE STUDY: Our aim was to propose and examine the outcomes of a comprehensive strategy for the management of cystic liver hydatidosis (CLH) based on extensive intraoperative assessments and optimal management of cystobiliary communications.

BACKGROUND DATA: Although operative intervention remains the preferred treatment  for CLH, and the presence of a cystobiliary communication remains a well-established predictive factor for postoperative complications, no internationally accepted management strategy integrates the specific management of cystobiliary communication into the choice of surgical approach.

METHODS: Early postoperative outcomes were compared before (1990-2004; P1 group;  n = 664) and after (2005-2013; P2 group; n = 156) the implementation of a CLH surgical management strategy for CLH in our overall group of patients in subgroups selected by risk factors (as determined by multivariate analysis), and  in 2 propensity score-matched groups.

RESULTS: Specific complications related to the hepatic procedure (intraabdominal  complications) were independently associated with the presence of ≥ 3 cysts (P =  .013), a fibrotic pericyst (P = .005), a cystobiliary communication (P < .001), and the P1 treatment period (P = .002). Between P1 and P2 groups, the rate of specific complications decreased in the overall group of patients with CLH (18.3% vs 4.5%; P < .001).

The rate also decreased in risk factor-based subgroups:

patients with ≥ 3 cysts (31.0% vs 4.0%; P = .005), a fibrotic pericyst (23.1% vs  9.2%; P = .011), and a cystobiliary communication (33.0% vs 13.2%; P = .006).

After propensity score matching among 123 well-balanced matched pairs of patients, the overall complication rate, specific hepatic surgery-related complication rate, and median duration of hospital stay decreased between the P1 and P2 groups: 23.6% vs 12.2% (P = .02), 21.1% vs 4.9% (P < .001), and 7 vs 5 days (P < .001), respectively.

CONCLUSION: Implementation of a CLH surgical management strategy based on specific intraoperative assessment and optimal management of cystobiliary communications improved early postoperative outcomes.

DOI: 10.1016/j.surg.2015.10.029

PMID: 26747223  [Indexed for MEDLINE]

Surgery. 2016 Apr;159(4):1170-80. doi: 10.1016/j.surg.2015.10.029. Epub 2015 Dec 31.

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