Abstract
BackgroundPartial peri-cystectomy (PPC) is one of the major surgical approaches for hepatic cystic echinococcosis (CE) and has been practiced in most centers worldwide. Cysto-biliary communication (fistula, leakage, rupture) is a problematic issue in CE patients. T-tube is a useful technique in situations where an exploration and decompression are needed for common bile duct (CBD). However, postoperative biliary complications for cystic cavity still remains to be studied in depth.MethodsA retrospective cohort analysis of CE cases in our single center database from 2007 March to 2012 December was performed. Patients (n = 51) were divided into two cohorts: double T-tube drainage (one at CBD for decompression and one at the fistula for sustaining in cystic cavity, n = 23) group and single T-tube drainage cohort (only one at CBD for decompression, n = 28). Short-/long-term postoperative complications focusing on biliary system was recorded in detail and they were followed-up for median 11 years.ResultsOverall biliary complication rates for double and single T-tube drainages were 17.4% vs. 39.3% (P > 0.05). Short-term complications ranged from minor to major leakages, cavity infection and abscess formation, and prevalence was 17.4% vs. 21.4% (P > 0.05) respectively for double and single T-tube groups; most importantly, double T-tube drainage group had obvious advantages regarding long-term complications (P < 0.05), which was biliary stricture needing surgery and it was observed only in single T-tube drainage group.ConclusionsDouble T-tube drainage had better outcomes without procedure-specific postoperative biliary complications than single T-tube drainage. Meanwhile, we recommend long-term follow-up when comparing residual cavity related biliary complications in CE patients as it could happen lately.
Highlights
Partial peri-cystectomy (PPC) is one of the major surgical approaches for hepatic cystic echinococcosis (CE) and has been practiced in most centers worldwide
Invisible or occult communication occurs in 10–37% of CE patients, frank cysto-biliary communication (FCBC) is an open intercommunication between the cystic cavity and intrahepatic bile ducts that allows the contents of the cyst to drain directly into the bile duct as well as biliary poring into the cystic cavity [7]
PPC was performed in all patients; debris in biliary tracts was removed through common bile duct (CBD) using choledochoscopy after cholecystectomy; biliary tract was explored by injecting methylene blue (1:250 dilution with normal saline) to discover the FCBC site (Fig. 3)
Summary
Partial peri-cystectomy (PPC) is one of the major surgical approaches for hepatic cystic echinococcosis (CE) and has been practiced in most centers worldwide. Cysto-biliary communication (fistula, leakage, rupture) is a problematic issue in CE patients. Mortality of echinococcosis is > 90% within 10–15 years if left untreated or inadequately treated after initial diagnosis. Radical resections, such as total peri-cystectomy with non-opened cyst and liver resection are considered as the best curable options [2, 3]. Communication between cystic cavity and the intra-hepatic biliary tracts could be classified as major (> 5 mm in diameter), minor (< 5 mm in diameter) and invisible (occult, hard to observe with naked eye but definitely exists). FCBC could cause obstructive jaundice, cholangitis, cystic infection, gastrointestinal discomfort and naplulaxis [8]
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