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Significance of bile leaks complicating conservative surgery for liver hydatidosis

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Abstract

Hepatic hydatidosis presents a challenge in liver surgery, and there is still controversy regarding the appropriate surgical technique. A high incidence of postoperative bile leaks is reported as a significant disadvantage of conservative surgical procedures. The purpose of this study was to examine the incidence and clinical importance of bile leakage in patients being treated exclusively by a conservative surgical technique. From January 1985 to November 2000 a total of 187 patients were operated on at our department for hepatic hydatidosis. They were subjected to the standard conservative surgical technique (wide unroofing and cyst drainage). A total of 18 complications were related to bile leakage (10%), 3 of them bile abscesses (1 drained surgically and 2 percutaneously), 1 case of bile peritonitis due to an accessory bile duct in the gallbladder bed (treated surgically), and 14 fistulas (1 bronchobiliary and 13 biliocutaneous). Five of the fistulas, including the bronchobiliary one, were treated successfully by endoscopy; and the remaining nine healed after conservative treatment. Bile leakage, representing a significant complication following conservative operations for hepatic hydatidosis, can be effectively treated conservatively or endoscopically, not justifying more aggressive surgical approaches.

Résumé

L’hydatitose hépatique représente un véritable challenge en chirurgie hépatique, alors que la meilleure technique chirurgicale est toujours controversée. L’incidence de fistules biliaires postopératoires est élevée: elles représentent l’inconvénient majeur des procédés chirurgicaux conservateurs. Le but de cette étude a été d’analyser l’incidence et l’importance clinique des fuites biliaires chez les patients traités exclusivement par une technique chirurgicale conservatrice. Entre janvier 1985 et novembre 2000, 187 patients ont été opérés dans notre département pour hydatitose hépatique: le procédé chirurgical, standardisé, était conservateur (résection large du dôme saillant et drainage du kyste). Il y avait au total 18 complications en rapport avec une fuite biliaire (10%), trois abcès biliaires (un drainé chirurgicalement et deux par voie percutanée), une péritonite biliaire en rapport avec un canal biliaire accessoire du lit vésiculaire (traitée chirurgicalement), et 14 fistules (une fistule biliobronchique et 13 biliocutanées). Cinq des fistules, y compris la fistule biliobronchique ont été traitées avec succès par voie endoscopique, alors que les neuf autres ont guéri par un traitement conservateur. La fuite biliaire, une des complications possibles après intervention conservatrice pour hydatose hépatique, peut être traitée efficacement de façon conservatrice et endoscopiquement, et ne justifie pas une approche chirurgicale, plus agressive.

Resumen

La hidatidosis hepática constituye un desafío en el campo de la cirugía del hígado y todavía se mantiene la controversia acerca de cuál es la técnica quirúrgica más apropiada. Se informa una elevada tasa de fuga biliar postoperatoria como una desventaja significativa de los procedimientos quirúrgicos conservadores. El propósito del presente estudio fue determinar la incidencia y la importancia clínica de la fuga biliar en pacientes manejados con técnica quirúrgica conservadora exclusivamente. Entre enero de 1985 y noviembre de 2000 se operaron 187 pacientes con hidatidosis hepática en nuestro Departamento utilizando una técnica quirúrgica conservadora estandarizada (destechamiento amplio y drenaje del quiste). Se registraron 18 complicaciones relacionadas con fuga biliar (10%), tres de ellas fueron absceso (uno drenado quirúrgicamente y dos en forma percutánea), una peritonitis biliar debida a un conducto biliar accesorio en el lecho de la vesícula biliar (tratado quirúrgicamente) y 14 fístulas (una broncobiliar y 13 biliocutáneas). Cinco de las fístulas, incluyendo la bronchobiliar, fueron manejadas exitosamente mediante endoscopia, en tanto que las nueve restantes cicatrizaron con tratamiento conservador. Las fugas biliares, que representan una complicación significante de las operaciones conservadoras en la hidatidosis hepática, pueden ser efectivamente tratadas con manejo conservador o endoscópico, y no se justifican conductas quirúrgicas más agresivas.

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Published Online: March 26, 2002

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Skroubis, G., Vagianos, C., Polydorou, A. et al. Significance of bile leaks complicating conservative surgery for liver hydatidosis. World J. Surg. 26, 704–708 (2002). https://doi.org/10.1007/s00268-002-6259-y

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