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Background <p>Cystic echinococcosis, mainly caused by <i>Echinococcus granulosus</i>, is a&#xa0;parasitic disease that impacts multiple organs, with the liver most frequently affected. Despite decreasing incidence, hepatic cystic echinococcosis remains a&#xa0;serious health problem in endemic areas. Conservative surgical procedures are commonly employed for treatment; however, they are associated with higher risks of biliary complications. This research aims to determine the factors affecting postoperative biliary complications in patients undergoing conservative surgery for liver hydatid cysts.</p> Methods <p>A&#xa0;retrospective analysis was performed in patients who underwent partial cystectomy for hepatic cystic echinococcosis from October 2010 to December 2023. Patient demographics, preoperative clinical and biochemical characteristics, cyst features, and postoperative outcomes were analyzed. Biliary complications were defined as biliary leakage, fistulas, and deep surgical site infections. The diagnostic accuracy of preoperative biochemical markers was evaluated by receiver operating characteristic (ROC) analysis.</p> Results <p>Included in the study were 85&#xa0;patients, with 24&#xa0;experiencing biliary complications. Patients experiencing biliary complications exhibited significantly elevated preoperative direct bilirubin (<i>p</i> = 0.01) and alkaline phosphatase levels (ALP; <i>p</i> = 0.007). The ROC analysis identified optimal cut-off values of 0.14 mg/dL for direct bilirubin and 90 IU/L for ALP. Cholecystectomy (<i>p</i> = 0.006) and intraoperative biliary communication (<i>p</i> = 0.034) occurred more frequently in patients experiencing biliary complications.</p> Conclusion <p>Elevated preoperative ALP and direct bilirubin levels, cholecystectomy, and intraoperative bile leakage are significant predictors of postoperative biliary complications following conservative surgery. Identifying high-risk patient cohorts that require early postoperative or preoperative decompression through endoscopic retrograde cholangiopancreatography, may lead to a reduction in morbidity.</p>

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Factors affecting postoperative biliary complications in patients undergoing conservative surgery for liver hydatid cysts

  • 期刊论文

  • 发表日期：

    2025年6月16日

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  • Doğuş Can Ekdal,
  • Baha Tolga Demirbaş

摘要

Background

Cystic echinococcosis, mainly caused by Echinococcus granulosus, is a parasitic disease that impacts multiple organs, with the liver most frequently affected. Despite decreasing incidence, hepatic cystic echinococcosis remains a serious health problem in endemic areas. Conservative surgical procedures are commonly employed for treatment; however, they are associated with higher risks of biliary complications. This research aims to determine the factors affecting postoperative biliary complications in patients undergoing conservative surgery for liver hydatid cysts.

Methods

A retrospective analysis was performed in patients who underwent partial cystectomy for hepatic cystic echinococcosis from October 2010 to December 2023. Patient demographics, preoperative clinical and biochemical characteristics, cyst features, and postoperative outcomes were analyzed. Biliary complications were defined as biliary leakage, fistulas, and deep surgical site infections. The diagnostic accuracy of preoperative biochemical markers was evaluated by receiver operating characteristic (ROC) analysis.

Results

Included in the study were 85 patients, with 24 experiencing biliary complications. Patients experiencing biliary complications exhibited significantly elevated preoperative direct bilirubin (p = 0.01) and alkaline phosphatase levels (ALP; p = 0.007). The ROC analysis identified optimal cut-off values of 0.14 mg/dL for direct bilirubin and 90 IU/L for ALP. Cholecystectomy (p = 0.006) and intraoperative biliary communication (p = 0.034) occurred more frequently in patients experiencing biliary complications.

Conclusion

Elevated preoperative ALP and direct bilirubin levels, cholecystectomy, and intraoperative bile leakage are significant predictors of postoperative biliary complications following conservative surgery. Identifying high-risk patient cohorts that require early postoperative or preoperative decompression through endoscopic retrograde cholangiopancreatography, may lead to a reduction in morbidity.