Surgical treatment of hydatid cysts with large biliocystic fistula results from a monocentric surgical experience

Background:  Hydatid cyst opened in the biliary tract constitutes an evolutionary turning point in the hydatid disease and risks to be life-threatening. Liver hydatid cysts with large biliocystic fistula is defined by the presence of a biliocystic fistula which is more than 5 mm in diameter and / or the presence of hydatid material in the common bile duct. The diversity of the pathological lesions of this disease and the lack of randomized controlled trials studying the different therapeutic techniques make those attitudes varied and sometimes debated. The purpose of this study was to study the different therapeutic possibilities as well as the difficulties posed by the large biliocystic fistula. Methods: This is a retrospective study of all consecutive patients (n=51), operated on for liver hydatid cysts with a large biliocystic fistula, between January 2003 and December 2012. The average age in this series was 39 years. There were 21 men and 30 women. An acute cholangitis was present in 47% of cases. Results:  The treatment of hydatid cyst was conservative (cyst unroofing) in 90% of cases and radical in 10% of cases. The large biliocystic fistula was treated by internal transfistulary drainage (21%), cystobiliary disconnection by trans-parieto-hepatocystic fistulisazion (35%), bipolar drainage (25%), direct suture of the fistula (8%) and liver resection (10%). The specific morbidity rate was 27% (n = 14). No deaths have been observed. The average follow-up was 22 months. Six cases of recurrence were observed. Conclusions:  The treatment of intrabiliary rupture of echinococcal cysts is not consensual. The internal transfistulary drainage and the transparietohepatocystic fistulization represent the techniques of choice in case of conservative surgery. Prevention remains the best treatment.