Management of biliary duct confluence injuries produced by hepatic hydatidosis

From 1978 to 1999 a total of 850 patients underwent surgical treatment for hydatid disease of the liver at our surgical department. Biliary duct confl uence injuries produced by hepatic hydatidosis (HH) were founded in six pat ients (0.7%). Surgical intervention was undertaken to relieve the obstructi ve jaundice and clinical manifestations of cholangitis and to treat the hyd atid cyst. A partially open cystopericystectomy technique was used in three patients with a double bilioenteric Roux-en-Y reconstruction. The remainin g three patients (two with prehepatic portal hypertension and one with trip le hepatic duct confluence) were subjected to a cystojejunostomy. There wer e no hospital deaths. Two cases of anastomotic leakage following a high bil ioenteric anastomosis occurred but did not require surgical treatment. Duri ng the follow-up (5-19 years) one patient suffered local recurrence of the hydatid disease 7 years after cystojejunostomy. The site of intrahepatic bi liary and vascular involvement, the presence of biliary duct anomalies, and the presence of portal hypertension are decisive factors when choosing the "ideal" procedure for reconstruction. Conservative surgical approaches (pa rtial cystectomy and cystojejunostomy) are the treatments of choice. Radica l surgery is often a serious matter.