Surgical approach to giant hepatic hydatid cysts: a single-center experience from Istanbul

Background: The aim of this study was to determine the presence of cystobiliary communication (CBC) and to assess the treatment and follow-up of existing and postoperative fistulae in giant hepatic hydatid cysts managed by either conservative or radical surgery. Methods: A total of 40 patients with hepatic hydatid cysts of 10 cm or greater in diameter were examined. These patients were seen in the General Surgery Clinic between January 2005 and June 2015. Conservative and radical surgeries were performed in 25 (62.5%) and 15 patients (37.5%), respectively. In patients that underwent conservative surgery, perioperative cholangiography was performed following pericystectomy and cholecystectomy by passing a 6F nelaton catheter through the cystic duct. Presence of CBCs and daughter vesicles was assessed. Results: Perioperative fistula was detected in 15 patients (60%) in the conservatively managed group. Successful closure with primary suturing was achieved in 14 patients (93%). One patient (7%) developed a postoperative biliary fistula (PBF). Of the 10 cases that were free of fistulae perioperatively, 4 (16%) developed PBF. True positivity and false negativity rates for detecting perioperative fistulae were 84% and 16%, respectively. Choledochoduodenotomies with T-tube drainage were performed in 2 out of 5 patients in which daughter vesicles were detected in the biliary tree. Duodenotomies with sphincteroplasty were performed in the remaining 3. Conclusion: Cholecystectomy with partial cystectomy and perioperative visualization of the biliary tree is a safe and useful procedure for management of giant hepatic hydatid cysts.