Hydatid cyst open in biliary tract: Therapeutic approaches. Report of 22 cases

Goal: Discuss the different therapeutic options based on results of a series of patients undergoing operation for hydatid cyst ruptured into the biliary tract. Patients and methods: This was a retrospective study of 22 patients operated on between 2001 and 2007 for hydatid cyst ruptured into the biliary tract. Results: The mean age of patients was 37 years old. There were 14 men and eight women. Cholangitis was present in 59% of patients and isolated pain in the right upper quadrant was found in 20% of patients. Procedures performed included internal fistula drainage through the sphincter of Oddi (37.3%), cystobiliary disconnection by percutaneous transhepatic cystochole-dochostomy (27.3%), bipolar drainage (27.3%), direct suture closure of the fistula (9.1%). The postoperative course was uneventful in 15 patients. Specific morbidity concerned four patients. An external biliary fistula and suppuration of the residual cavity was observed in two patients each. One patient died. Median survival was 24 months. No recurrence or late complications were seen in this series. Conclusion: The management of hydatid cyst ruptured into the biliary tract is not consensual. Radical treatment is best because it provides definitive treatment of both the fistula and the cyst at the same time. However, conservative treatment is the preferred treatment in endemic countries. The choice of the technique depends of the experience of the surgeon, as well as local and topographic conditions. The best treatment remains preventive by eradication of echinococcosis. (C) 2011 Elsevier Masson SAS. All rights reserved.