Management of complicated hepatic hydatid cysts: Our single-center experience.

Abstract

Background: This study aims to evaluate preoperative laboratory and radiological findings in patients with hydatid cysts to predict the severity of postoperative complications and identify markers of clinical deterioration. The goal is to refine treatment strategies, optimize clinical decision-making, and improve postoperative quality of life in the management of complicated hydatid disease.

Methods: This retrospective study included 74 patients who underwent surgical treatment for hydatid disease at our institution between September 2016 and September 2021. Patients with high American Society of Anesthesiologists (ASA) scores or hepatic lesions other than hydatid cysts were excluded. Based on the Clavien-Dindo classification, patients were categorized into two groups: Group 1 (mild complications) and Group 2 (severe complications). All patients received preoperative and postoperative albendazole therapy (15 mg/kg/day). Clinical, demographic, laboratory, and imaging data, along with cyst characteristics, surgical approach, complications, and postoperative morbidity, were analyzed to identify predictive factors for outcomes and complications.

Results: Data from 74 patients who underwent surgery for hydatid disease were analyzed, with a median age of 43 years. The cohort was divided into two groups based on the Clavien-Dindo classification: Group 1 (mild complications, 81%) and Group 2 (severe complications, 19%). Statistically significant differences were observed in preoperative alkaline phosphatase (ALP) and hemoglobin (HGB) levels between the two groups (p<0.05). Most patients in Group 1 had simple cysts, while Group 2 showed a higher incidence of complicated cysts (p=0.023) and biliary fistulas (p=0.01). Postoperative complications, including percutaneous drainage, readmissions, and the need for endoscopic retrograde cholangiopancreatography (ERCP), were more frequent in Group 2 (p<0.001). Imaging modalities such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) identified biliary involvement as a significant predictor of severe morbidity. Additionally, elevated preoperative ALP levels (≥133 U/L) were found to be a significant risk factor for postoperative morbidity. Receiver operating characteristic (ROC) analysis showed that an ALP level ≥133 U/L had a sensitivity of 64.29% and a specificity of 86.67%, with an area under the curve (AUC) of 0.805. These findings underscore the importance of specific clinical and laboratory markers in predicting postoperative outcomes in hydatid disease surgery.

Conclusion: Effective management of liver hydatid cysts requires a multidisciplinary approach, combining surgical expertise, pharmacological treatment, and a comprehensive understanding of disease pathophysiology. Continued research is essential to refine treatment protocols, enhance surgical outcomes, and improve patients' quality of life. Our findings emphasize that specific clinical factors, such as cyst type, need for postoperative drainage, hospital readmissions, length of hospital stay, preoperative ALP levels ≥133 U/L, and biliary system involvement, are significant predictors of postoperative morbidity in patients undergoing surgery for hydatid disease.