Predisposing factors and surgical outcome of complicated liver hydatid cysts

Table 1 Patient and cyst characteristics of the three study groups

Characteristic	Group I (n = 28)	Group II (n = 93)	Group III (n = 251)	P
Age1 (yr)				0.001b
mean ± SD	36.32 ± 11.86	50.26 ± 13.88	45.62 ± 16.01
Median (range)	37.0 (17-76)	53.0 (23-76)	43.0 (18-79)
Sex				0.950
Male	15 (53)	51 (55)	141 (56)
Female	13 (47)	42 (45)	110 (44)
Previous hydatid disease surgery				0.204
No	24 (86)	74 (80)	219 (87)
Yes	4 (14)	19 (20)	32 (13)
Localization				0.109
Right lobe	17 (61)	54 (58)	178 (71)
Left lobe	5 (18)	25 (26)	48 (19)
Bilateral	6 (21)	14 (16)	25 (10)
No. of cysts1				0.284
1	22 (78)	61 (66)	193 (77)
2	4 (14)	17 (18)	39 (16)
3	1 (4)	7 (8)	16 (6)
4	1 (4)	5 (5)	3 (1)
5	-	3 (3)	-
Cyst diameter1 (cm)	9.5 (4-24)	10 (6-29)	7 (3-31)	0.001b
Position				0.017b
Superficial	24 (86)	52 (56)	155 (62)
Deep	4 (14)	41 (44)	96 (38)
Cyst infection				0.683
Negative	26 (93)	89 (95)	234 (93)
Positive	2 (7)	4 (5)	17 (7)

Values are mean ± SD, median (range), or n (%).

^bValues indicate a significant difference.

¹Kruskal-Wallis test.

Table 2 Multinominal logistic regression analyses of factors influencing peritoneal and biliary perforation of liver hydatid cysts

Factor	Group I vs group III		Group II vs group III
	Odds ratio	95% CI	Odds ratio	95% CI
Sex
Male	1.00		1.00
Female	1.61	0.68-3.77	1.10	0.65-1.87
Age	0.59	0.41-0.84	1.30	1.07-1.57
Occurrence type
Primary occurrence	1.00		1.00
Recurrence	0.81	0.23-2.77	1.33	0.66-2.65
Localization
Unilobar	1.00		1.00
Bilateral	1.48	0.86-2.55	1.54	1.07-2.21
No. of cysts	1.21	0.65-2.23	1.80	1.30-2.50
Cyst diameter (cm)	1.11	1.04-1.19	1.12	1.07-1.57
Position
Superficial	1.00		1.00
Deep	0.27	0.09-0.84	1.40	0.18-4.33
Cyst infection
Positive	1.00		1.00
Negative	1.02	0.20-5.11	0.58	0.17-2.01

Group I = 28, group II = 93, group III = 251 (reference value).

Table 3 Surgical procedures used

Surgical procedure	No. of cysts (%)
	Group I (n = 28)	Group II (n = 93)	Group III (n = 251)
Main surgical procedure
PP and drainage	26 (70.3)	101 (67.8)	231 (73.5)
PP and omentoplasty	2 (5.4)	13 (8.7)	26 (8.3)
PP and capitonnage	2 (5.4)	11 (7.4)	20 (6.4)
PP and intraflexion	-	3 (2.0)	8 (2.6)
Pericystectomy	5 (13.5)	14 (9.4)	19 (6.0)
Liver resection	2 (5.4)	7 (4.7)	10 (3.2)
Total No. of cysts	37	149	314
Additional surgical procedure
Choledochotomy and T-tube	3 (10.7)	77 (82.8)	7 (2.7)
Choledochotomy and choledochoduodenostomy or sphincteroplasty	1 (3.5)	16 (17.2)	2 (0.8)

PP: Partial pericystectomy.

Table 4 Morbidity, recurrence, and mortality rates of the three study groups n (%)

	Group I (n = 28)	Group II (n = 93)	Group III (n = 251)	P
Medical complications1				0.163
Cardiac	1 (3.6)	1 (1.1)	3 (1.2)
Respiratory	2 (7.2)	3 (3.2)	6 (2.4)
Other	1 (3.6)	2 (2.2)	4 (1.6)
Surgical complications
Wound infection	6 (21.4)	6 (6.5)	9 (3.5)	0.001b
Biliary fistula	1 (3.6)	9 (9.7)	2 (0.8)	0.001b
Intra-abdominal abscess	-	1 (1.1)	2 (0.8)	0.855
Incisional hernia	2 (7.2)	2 (2.2)	3 (1.2)	0.087
Gastrocutaneous fistula	1 (3.6)	-	-	0.002b
Recurrence	3 (10.7)	3 (3.2)	8 (3.2)	0.132
Mortality	-	1 (1.1)	3 (1.2)	0.844

^bValues indicate a significant difference.

¹Cardiac complications included heart failure and myocardial infarction; respiratory complications included atelectasis, pneumonia, adult respiratory distress syndrome, and pulmonary embolus; other complications included urinary tract infection and acute thromboembolic disease of the lower extremities.