Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study.
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Habeeb Tamer A A M, Podda Mauro, Tadic Boris, Shelat Vishal G, Tokat Yaman, Abo Alsaad Mohamed Ibrahim, Kalmoush Abd-Elfattah, Nassar Mohammed Shaaban, Mustafa Fawzy Metwally, Morsi Badawy Mahmoud Hassib, Sobhy Shaaban Mohamed, Mohamed Tarek Zaghloul, El Sayed Henish Mohammed Ibrahim, Elbelkasi Hamdi, Abdou Yassin Mahmoud, Mostafa Abdelshafy, Ibrahim Amr, A-Abdelhady Waleed, Elshahidy Tamer Mohamed, Mansour Mohamed Ibrahim, Moursi Adel Mahmoud, Abdallah Zaitoun Mohamed, Abd-Allah Ehab Shehata, Abdelmonem Elsayed Ashraf, S Elsayed Rasha, M Yehia Ahmed, Abdelghani Amr, Negm Mohamed, Abo-Alella Heba Alhussein, Elaidy Mostafa M
Аннотация
AIM: To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD.
METHODS: From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence.
RESULTS: There was a highly statistically significant association (P ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association (P ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively.
CONCLUSION: Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.