PREDICTORS OF CYSTOBILIARY COMMUNICATION IN HYDATID DISEASE OF LIVER, INTRA-OPERATIVE AND POST OPERATIVE MANAGEMENT IN CHILDREN AT A SINGLE INSTITUTION IN NORTHERN INDIA.

Abstract

Introduction: Hydatid disease in children is highly prevalent in this part of world due to lack of proper hygiene. Cystobiliary communication(CBC) with hepatic hydatid disease is responsible for postoperative bile leakage and morbidity . Aims: Our study aimed to predict the communication, intraoperatively diagnose it and manage it postoperatively in case not diagnosed previously. Material and Methods:This is a prospective , cohort study of all children with hydatid disease of the liver.Patient data were recorded on an internal web-based registry system supplemented by paper records. All the patients who underwent surgery for hydatid disease from 2013 to 2019 were assessed for presence of CBC and only patients with CBC were included in the study and studied. Results: A total of 97 patients presented with hydatid disease of liver during the said period.There were a toatal of 20 (20.6%) CBC among these .Males had more CBC than females (m:f=2:1). Conclusion: Cyst size >10cms,jaundice, right lobe cyst preoperatively were the most important predictors of CBC.It was found that on-table suturing of CBC with deposition of pedicled omentum was the most effective way of preventing post-operative bile-leak. Management depends on the size of the fistula, the site of the cyst, and the experience of the hepatobiliary surgeon.