Hydatid cysts of the liver opening in the biliary tracts: about 120 cases comparative study between radical and conservative treatment
Authors:   Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia, Talbi Ghofrane , Ferjaoui Wael ,   Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia, Omrani Sahir ,   Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia, Hajri Mohamed ,   Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia, Baccouche Seifeddine ,   Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia, Cherni Nizar ,   Department of Urology, Military Hospital of Tunis, Faculty of Medicine of Tunis, Tunisia, Gharbi Lasaad ,   Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia, Arfaa Nefaa ,   Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia, Mestiri Hafedh ,   Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia, Bayar Rached ,   Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia
Published: May 2022

Background. Hepatic hydatid disease is still common in Tunisia, is deemed benign disease but concerns its complications; the most frequent is the rupture in biliary ducts. The aim of the work was to study the results of surgical treatment of hydatid cysts of the open liver in the bile ducts and to deduce the predictive factors of postoperative complications. Methods. This was a retrospective study, done in the department of general surgery of Mongi Slim hospital, over a period of 11 years (from January 2000 to December 2013) and collecting 115 patients. Judging criteria were specific morbidity, length of postoperative stay and recurrence. Results. The median age was 43 years (62 women and 53 men). The clinic consisted of typical cholangitis episodes (6.95%), 6.95% of patients were asymptomatic. 50 radical interventions and 65 conservative interventions were performed, supplemented by treatment of the fistula as follows: Fistula blindness (43.47%), trans-fistulo-oddian drainage (3.4%), bipolar drainage (2.6%), PERDOMO (6.95%). The overall mortality was zero. The overall morbidity was 27.69% with an overall specific morality of 14.7% mainly represented by the suppuration of the CR and the external biliary fistulas. The median postoperative stay was 6 days; the recurrence rate was 1.7% with a delay of 30 months. The predictive factors of postoperative complications in bi variance were: The size of the cyst (p = 0.02), The location of a cyst in the hepatic dome (p = 0.002), Surgical treatment: radical or conservative (p = 0.02), The sex factor (p = 0.015). The multivariate study who found a significant association between sex only and postoperative complications. Conclusion. Advances in hepatobiliary surgery and anesthesia are changing the surgical attitude in favor of radical procedures with favorable consequences in terms of morbidity, length of stay and recurrence. It is believed that the surgeon’s experience is the most important factor in the success of surgical treatment. This helps to prevent complications.