Diagnosis and treatment modalities of hilar biliary duct stricture in hepatic cystic echinococcosis after endocystectomy.

Paizula Shalayiadang,Abduaini Abulizi,Ayifuhan Ahan,Qiang Guo,Tuerganaili Aji,Yingmei Shao,Tiemin Jiang,Hao Wen,Bo Ran,Ruiqing Zhang

doi:10.1051/parasite/2021051

Abstract

Aim: Hilar biliary duct stricture may occur in hepatic cystic echinococcosis (CE) patients after endocystectomy. This study aimed to explore diagnosis and treatment modalities. Methods: Clinical data of 26 hepatic CE patients undergoing endocystectomy who developed postoperative hilar biliary duct stricture were retrospectively analyzed and were classified into three types: type A, type B, and type C. Postoperative complications and survival time were successfully followed up. Results: Imaging showed biliary duct stenosis, atrophy of ipsilateral hepatic lobe, reactive hyperplasia, hepatic hilum calcification, and dilation or discontinuity of intrahepatic biliary duct. All patients received partial hepatectomy to resect residual cyst cavity and atrophic liver tissue, and anastomosis of hepatic duct with jejunum or common bile duct exploration was applied to handle hilar biliary duct stricture. Twenty-five patients were successfully followed up. Among type A patients, one patient died of organ failure, and upper gastrointestinal bleeding and liver abscess occurred in one patient. Moreover, calculus of intrahepatic duct was found in one type B and type C patient. Conclusion: Long-term biliary fistula, infection of residual cavity or obstructive jaundice in hepatic CE patients after endocystectomy are possible indicators of hilar bile duct stricture. Individualized and comprehensive treatment measures, especially effective treatment of residual cavity and biliary fistula, are optimal to avoid serious hilar bile duct stricture.

Highlights

Cystic echinococcosis (CE), a widely distributed zoonosis, still continues to be a significant economic burden and public health issue, causing an average of 285,500 disability-adjusted life years [7,8,9]
All hepatic CE patients included in this study underwent endocystectomy from January 2005 to January 2018, and there were postoperative complications of hilar biliary duct stricture
Based on our experience and other studies [14, 24], hepatectomy may be used as a preferred treatment modality in the following situations: (a) several CE cysts were confined to one hepatic segment or hepatic lobe; (b) there were recurrent thick wall cysts accompanied by intracystic infection or granuloma formation; and (c) there was biliary fistula in the remnant cavity with long-term tube or repeated debridement without recover

Summary

Introduction

Cystic echinococcosis (CE), a widely distributed zoonosis, still continues to be a significant economic burden and public health issue, causing an average of 285,500 disability-adjusted life years [7,8,9]. CE cysts mainly develop in the internal organs of humans or other intermediate hosts, with the liver and lungs being the most common target organs [12, 30]. Periadventitial cystectomy (total cystectomy) is a preferred choice in clinical settings. If CE cysts are adjacent to major vessels, sub-total cystectomy is considered without vessel dissection. When the CE lesion is huge and close to vessels or biliary ducts of porta hepatis, endocystectomy (partial cystectomy) may be feasible [16, 28]

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