Intraoperative Drains and Surgical Management of Biliary Complications After Endocystectomy for Hepatic Cystic Echinococcosis are Beneficial

Introduction Cystic echinococcosis (CE) is a parasitic disease caused by Echinococcus granuloses. The ideal surgery method is a matter of debate. However, new studies have shown many advantages of endocytectomy. The main complication of endocytectomy is bile leak. We evaluated two different bile leak management strategies, surgical revision versus interventional therapy, comparing their outcomes, and cost/effectivity.

Methods Eighty patients (181 cysts) who underwent endocystectomy between 2005 and 2020 were investigated. Surgical procedures were performed using our standardized method and complication management were based on both hospital standards and surgeon’s discretion. Perioperative data were analyzed, and results of bile leak management using different strategies were compared regarding the hospitalization and costs reimbursement through DRG-costs.

Results Postoperative complications were detected in 16 (20 %) patients . Postoperative Bile leak was seen in 12 patients with total rate of 8.1% in operated cysts . Bile leaks were diagnosed using the intraoperative drains in ten cases (83%). The median hospitalization was 10 days. The median DRG-cost was 8,262€. CE recurrence was reported in two patients (2.5%).

Discussion Standardized endocystectomy is safe and efficient, with complication and relapse rate similar to radical surgery. Surgical drains led to early diagnosis of bile leak. The patients with early reoperation had a shorter hospitalization (12.5 vs 20.7) and the DRG-based cost-reimbursements were slightly higher in these patients in comparison to those with interventional therapies. Therefore, it seems that routine usage of surgical drains and prompt reoperation in cases of early bile leak are beneficial.

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Artikel online veröffentlicht:
26. Januar 2022