Comparison of post-operative short-term and long-term outcomes between occult and frank biliary rupture of hydatid disease.

BACKGROUND/AIMS: Intrabiliary rupture (IBR) is the most common and serious complication of hepatic hydatid cyst (HHC). The aim of this retrospective study was to evaluate postoperative short-term and long-term outcome of patients treated surgically for complicated liver hydatid cysts. METHODOLOGY: A total of 168 cases with biliary communication of hydatid cyst were analyzed retrospectively, 92 of which had biliary communication with an occult rupture while 76 (45.23%) had Frank biliary rupture. Preoperative demography, ultrasonic cyst features, postoperative short-term complications, postoperative follow-up (long-term) complications and hospital stay were recorded and analyzed. RESULTS: There were no differences in the demographic characteristics and preoperative cyst features in Frank and occult group. Compared with the Frank group 9.34 +/- 1.25 (days), the postoperative stay in occult 6.97 +/- 1.62 (days) were relatively shorter. The incidence of overall postoperative short-term complications and long-term complications were insignificantly lower in occult group (22.82%) than Frank group (30.26%) with P = 0.275. Incidence of postoperative biliary leakage 8 (8.69%) and abscess 5 (5.43%) in occult group was insignificantly more common than Frank rupture with biliary leakage 5 (6.5%) and abscess 2 (2.63%) with P value was 0.609 and 0.365 respectively while long-term biliary stricture is significantly greater in Frank group (10.52%) then occult group (0%) with P = 0.01. CONCLUSIONS: Frequency of occurrence of postoperative short-term complications biliary fistula and abscess is relatively more common in occult rupture with transcystic drain due to its indolent course, inability to find and suture the rupture orifice, and incomplete decompression while biliary stricture is significantly more common in Frank group due to its involvement of major bile ducts.