Bile leaks following surgery for hepatic hydatid disease.
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2005-03-10
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Abstract
BACKGROUND: Conservative surgery (cyst evacuation and partial pericystectomy) for hydatid cysts of the liver is known to be safe but is often associated with bile leak and its sequelae.
METHODS: Case records of 86 patients undergoing surgery for hydatid cysts of the liver at a tertiary-care center in northern India over a 14-year period were reviewed retrospectively.
RESULTS: Sixteen (18%) patients had jaundice and 36 (42%) had a cyst-biliary communication detected at surgery. Biliary complications developed in 14 (16%) patients. Bile leaks and bilio-cutaneous fistulae were observed in 11 (13%) patients; the fistula output was low (< 300 mL/day) in 8 of these. Three patients had localized intra-abdominal bile collections; all 3 underwent percutaneous drainage of biloma (subsequent laparotomy and lavage was required in one patient due to failure of percutaneous drainage), producing controlled low-output bilio-cutaneous fistulae in all. All low-output fistulae closed spontaneously after a mean duration of 4 weeks. Patients with high-output fistulae underwent endoscopic intervention (stenting/naso-biliary drainage), resulting in the conversion of these fistulae to low-output category and eventual closure after a mean duration of 7.5 weeks.
CONCLUSION: Postoperative bile leaks lead to significant morbidity after surgical management of hydatid cysts of liver. A majority of them resolve spontaneously. Biliary drainage (endoscopic or surgical) hastens the closure of these bilio-cutaneous fistulae.
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Agarwal S, Sikora SS, Kumar A, Saxena R, Kapoor VK. Bile leaks following surgery for hepatic hydatid disease. Indian Journal of Gastroenterology. 2005 Mar-Apr; 24(2): 55-8