Management of Biliary Duct Confluence Injuries Produced by Hepatic Hydatidosis

Abstract

From 1978 to 1999 a total of 850 patients underwent surgical treatment for hydatid disease of the liver at our surgical department. Biliary duct confluence injuries produced by hepatic hydatidosis (HH) were founded in six patients (0.7%). Surgical intervention was undertaken to relieve the obstructive jaundice and clinical manifestations of cholangitis and to treat the hydatid cyst. A partially open cystopericystectomy technique was used in three patients with a double bilioenteric Roux-en-Y reconstruction. The remaining three patients (two with prehepatic portal hypertension and one with triple hepatic duct confluence) were subjected to a cystojejunostomy. There were no hospital deaths. Two cases of anastomotic leakage following a high bilioenteric anastomosis occurred but did not require surgical treatment. During the follow-up (5-19 years) one patient suffered local recurrence of the hydatid disease 7 years after cystojejunostomy. The site of intrahepatic biliary and vascular involvement, the presence of biliary duct anomalies, and the presence of portal hypertension are decisive factors when choosing the "ideal" procedure for reconstruction. Conservative surgical approaches (partial cystectomy and cystojejunostomy) are the treatments of choice. Radical surgery is often a serious matter.

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

“…In a series in which LHC were mostly treated by conservative surgery, Kayaalp et al [5] concluded that cysts near the hilar plate presented more leaks and postoperative biliary fistulas, a high rate of complications involving the cystic cavity, and longer hospital stay. The only study that dealt exclusively with the problem of CBC located in the hilar plate was performed by De Vicente et al [15] with a series of 6 cases. The technique performed was partial resection of the cyst and double hepatojejunostomy (HJ) in 3 patients and cystojejunostomy in 3 others.…”

“…ERCP appears to be less useful in patients with hilar plate CBC than in patients with FIR in other locations [14]. Intraoperative cholangiography may also be useful [15]. …”

“…Several methods have been used to diagnose CBC, with ultrasound and abdominal CT being the most frequent [7,15]. Preoperative ERCP with sphincterotomy is emerging as a therapeutic strategy in patients with suspected CBC, and it was performed in our 4 patients [16,17].…”

“…Several technical options are available for treating LHC located in the hilar plate with CBC [15]. Two key factors influence the choice of technique: the anatomical relationships between the LHC and vasculobiliary structures, and the biliary anatomy [15].…”

“…Hilar plate CBC represents a major surgical challenge and these patients have traditionally been treated with conservative surgery [15]. We report on 4 patients with frank intrabiliary rupture (FIR) in the hilar plate who were treated with hepatectomy and hilar plate reconstruction.…”