Internal transfistulary drainage for intrabiliary rupture of hydatid cyst of the liver: Analysis of the indications and the results. Report of 50 cases.

Background: The rupture of hydatid cyst of the liver into the biliary tracts through a large fistula is one of the most difficult complications to treat. The techniques are various and each has its own morbidity. Internal transfistulary drainage is a surgical method of treatment of hydatid cysts of the liver opening in the biliary tract.

Aims: The aim of this study was to identify the risk factors of specific postoperative complications of this surgical technique Methods: During the period's study, 823 patients with liver hydatid cyst were operated. 86 (11 %) of them were opened in the bile ducts through a large fistula. 50 patients (58 %) had internal transfistulary drainage.

Results: The sex ratio was 1.6. The population was young with an average age of 40.8 years. The most frequent clinical feature of the opening in the biliary tract was acute cholangitis (42 %). The most common location of hydatid cyst was at the hepatic dome. The pericyst was flexible in only 62 % of cases. Thick pericysts were made flexible in 20% of cases and partly resection of protruding dome was made in 36 % of cases. Specific morbidity rate was 16% with no mortality. The uni and multivariate analysis had identified as risk factors for specific complications: the thick pericyst (P = 0.04), a size of the residual cavity ≥ 9cm; non visualization of the residual cavity on the post operative cholangiography was of borderline statistical significance (P = 0.049).

Conclusion: The internal transfistulary drainage is an easy and reliable surgical technique, its morbidity is low. It's indicated in the cases of large fistula with a thin pericyst and a diameter of the residual cavity less than 09 cm. Making thick pericyst flexible is a false security for the indication of internal transfistulary drainage and the non visualization of the residual cavity on the post operative cholangiography impose more frequent control for these patients since they are at risk of complications.