External Tube Drainage Versus no Drainage in Hepatic Hydatid Cysts with Cystobiliary Communications

Abstract

Echinococcosis (hydatid disease) is a zoonosis caused by the larval stage of Echinococcus granulosus. About seventy-five per cent of all hydatid cysts are found in the liver. Surgical management of hepatic hydatid cyst includes neutralization of the parasite, evacuation of cyst, removal of germinal lining and management of the residual cavity. Our study focussed on the management of the residual cavity in patients with cystobiliary communications. We divided the patients into two groups of 40 patients each. In both the groups the cystobiliary communications were ligated using sutures. After closing the cystobiliary communications, the residual cavity was left to drain externally using a polyvinyl chloride tube in group 1 whereas either capitonnage or omentoplasty was done in group 2. The results were studied in terms of the postoperative complications, mortality and hospital stay. In the patients managed by external tube drainage, average hospital stay was 6.95 ± 0.93 days while as patients in group 2 had an average post operative stay of 4.54 ± 0.76 days (p value = 0.0001). Bile leak was seen in 6 (15%) patients in group 1, while as only 1(2.5%) patient from group 2 developed an intra-abdominal bile collection. Wound infection and deep vein thrombosis was seen in one patient each in group 1, whereas no such complication was seen in group 2. One (2.5%) patient from each group had a recurrence of the disease during follow-up.