Frank Intrabiliary Rupture in Liver Hydatidosis Located in the Hilar Plate: A Surgical Challenge

Abstract

Background: Frank intrabiliary rupture (FIR) is a severe complication that occurs in around 30% of patients with liver hydatidosis. When FIR is present, the contents of the cyst may pass into the common bile duct and cause a variety of complications. If the FIR is located in the hilar confluence, surgical repair is a challenge. Currently there are no data regarding its optimum treatment. Material and Methods: Between May 2007 and December 2012, we treated 59 patients with liver hydatidosis. Four patients, all women, with a mean age of 51.7 years, had hydatid cysts located between segments IVb and V and FIR affecting the hilar plate. In 3 cases, the initial clinical condition was obstructive jaundice. The fourth patient presented recurrence after having undergone two operations as a child. Results: In each patient a major hepatectomy was performed with hilar plate reconstruction (3 left and 1 right). Morbidity included mild biliary fistula (1 patient) and abdominal collection resolved by percutaneous drainage (1 patient). There was no mortality. During follow-up (47 months), no recurrences of the disease or biliary strictures were recorded. Conclusions: FIR is a severe complication of liver hydatidosis. When it is located in the hilar confluence, liver resection may be the best surgical option for definitive resolution of the problem.

Surgical strategies in the treatment of liver hydatid cyst

“…A total of 301 records were recovered, 47 of which fulfilled the selection criteria: three SR, 14,16,17 three CT, [18][19][20] five cohorts studies, 5,21-24 24 case series 4,6,10,11,21,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] and 12 not classifiable OS. 7,8,13,26,[44][45][46][47][48][49][50][51] The studies had a level of evidence of 1b, 2a, 2b, 3a and 4 of prognostic and therapy scenarios.…”

“…A total of 301 records were recovered, 47 of which fulfilled the selection criteria: three SR, three CT, five cohorts studies, 24 case series and 12 not classifiable OS . The studies had a level of evidence of 1b, 2a, 2b, 3a and 4 of prognostic and therapy scenarios.…”

“…22 In these cases, there is uncertainty based on a different evidence, which endorses a simple suturing of these ruptures or the need to perform a decompression choledochostomy that is either isolated or associated with the suturing (evidence type 1b and 4). 22,41,49 We prefer absorbable sutures to choledochostomy, as it has a lower rate of morbidity, which leaves the patient with an ostomy for a considerable period of time; therefore, we indicate this only where there is certainty of cholangiohydatidosis with or without secondary acute cholangitis, or when a coexisting choledocholithiasis is diagnosed (evidence type 1b). 22,23 Cholangiohydatidosis.…”

Surgical Alternatives Used in the Treatment of Liver Hydatid Cyst: A Systematized Approach Based on Evidence (an Overview)

“…This stage does not apply in all cases, but rather only in those where one of the following situations exists: Frank intrabiliary rupture: Cyst-biliary communication is a frequent evolutionary complication, the prevalence of which is around 26 % of patients with HE (Manterola et al, 2009b). In these cases, there is uncertainty based on a different type of evidence, which endorses simple suturing of these ruptures or the need to perform a decompression choledochostomy that is either isolated or associated with the suturing (evidence type 1b and 4) (Manterola et al, 2009b;Ramia et al, 2013;Shalayiadang et al, 2014). We are inclined to use absorbable sutures and not perform the choledochostomy, because the procedure is not without morbidity, and leaves the patient with an ostomy for a considerable period of time; therefore, this is indicated only where there is certainty of cholangiohydatidosis with or without secondary acute cholangitis, or when a coexisting choledocholithiasis is diagnosed (evidence type 1b) (Manterola et al, 2009b;Manterola et al, 2010b).…”