Diagnosis and management of postoperative complications after percutaneous perhepatic echinococcectomy

Aim . To assess complications after percutaneous treatments for patients with liver hydatid echinococcosis. Material and methods . From 2004 to 2024, 102 patients with hepatic hydatid echinococcosis were treated with percutaneous therapy. Recurrent and complicated echinococcal cysts were reported in 9 (8.8%) and 6 (5.8%) patients, respectively. Results . Percutaneous treatments were successful in 100 (98%) patients. Postoperative complications developed in 28 (27.4%) patients, including residual bleeding, residual cavity infection, and cystobiliary fistula in 3 (2.9%), 4 (3.9%), and 21 (20.6%) cases, respectively. In 13 patients, cystobiliary fistulas closed spontaneously; in 6 patients, they closed after changing the drainage type. The presence of cystobiliary fistula significantly prolonged the duration of external drainage. The duration of external drainage in case of echinococcal cyst complicated by cystobiliary fistula was 87.0 ± 3.6 days; without cystobiliary fistula, the duration was 32.0 ± 2.8 days. Echinococcal cysts >70 mm were significantly more likely to develop cystobiliary fistula after surgery (p < 0.05). Conclusion. Cystobiliary fistula is the leading postoperative complication diagnosed in 20.6% cases. Its development affects the treatment policy and significantly increases the duration of external drainage. The size of an echinococcal cyst is a significant predictor of cystobiliary fistula formation after surgery.