Postoperative Bile Leak in Liver Hydatid Cyst: When to Intervene?

Background: Postoperative bile leak (POBL), a major concern in liver hydatid cyst (LHC) surgery, can be managed either conservatively or by endoscopic therapy. There is a need for some objective parameters to guide endoscopic therapy for POBL in LHC surgery.

Setting: This study was carried out in the Department of Surgical Gastroenterology in a tertiary care centre in Northern India.

Materials and methods: A total of 116 surgically managed patients for LHC were analysed retrospectively using regression analysis and receiver operating characteristics (ROC) curves to identify factors predicting endoscopic therapy in POBL.

Results: POBL was found in 31.8% (37 of 116) of patients. Most of the patients had POBL <300 mL/day (67.6%). Patients with POBL experienced more morbidity (P = 0.0001) in comparison with patients without POBL. Out of 37 patients with POBL, 22 (59.5%) were managed conservatively, and 15 (40.5%) were managed with endoscopic retrograde cholangiopancreatography. Patients with POBL managed with endoscopic therapy had higher daily bile output (P = 0.055), longer time to removal of drain (P = 0.002), and longer postoperative stay (P < 0.0001) when compared with conservatively managed patients. Male gender [Odds ratio (OR) = 5.10, p=0.026], POBL >300 mL/day (OR = 5.143, P = 0.031), POBL >14 days (OR = 6.800, P = 0.010), and hospital stay >14 days (OR = 11.42, P = 0.007) predicted the need for endoscopic therapy in managing POBL. On ROC curve analysis, daily POBL >210 mL [area under the curve (AUC) = 0.773, P = 0.005] and POBL for >12.5 days (AUC = 0.826, P = 0.001) were cut-off values for the need for endoscopic therapy for managing POBL.

Conclusion: POBL in LHC surgery is a serious problem. Male patients with daily POBL >300 mL, bile leak >14 days, and hospital stay >14 days had higher chances for the need for endoscopic therapy.