Predictive Factors of Deep Abdominal Complications after Operation for Hydatid Cyst of the Liver: 15 Years of Experience with 672 Patients

El Malki, Hadj Omar; El Mejdoubi, Yasser; Souadka, Amine; Mohsine, Raouf; Ifrine, Lahcen; Abouqal, Redouane; Belkouchi, Abdelkader

doi:10.1016/j.jamcollsurg.2007.11.012

« Previous Next »Journal of the American College of Surgeons
Volume 206, Issue 4 , Pages 629-637, April 2008

Predictive Factors of Deep Abdominal Complications after Operation for Hydatid Cyst of the Liver: 15 Years of Experience with 672 Patients

Hadj Omar El Malki, MD
- Surgery Department “A,” Ibn Sina Hospital, Rabat, Morocco
- Medical Center of Clinical Trials and Epidemiological Study, Medical School, University Mohammed, V^th Souissi, Rabat, Morocco
- Correspondence address: Hadj Omar El Malki, MD, Surgery Department “A,” Ibn Sina Hospital, 10 rue Rif, Av Imam Malik, Rabat, Morocco.
Yasser El Mejdoubi, MD
- Surgery Department “A,” Ibn Sina Hospital, Rabat, Morocco
Amine Souadka, MD
- Surgery Department “A,” Ibn Sina Hospital, Rabat, Morocco
Raouf Mohsine, MD
- Surgery Department “A,” Ibn Sina Hospital, Rabat, Morocco
Lahcen Ifrine, MD
- Surgery Department “A,” Ibn Sina Hospital, Rabat, Morocco
Redouane Abouqal, MD
- Medical Center of Clinical Trials and Epidemiological Study, Medical School, University Mohammed, V^th Souissi, Rabat, Morocco
- Biostatical, Clinical Research and Epidemiological Laboratory, Medical School, University Mohammed, V^th Souissi, Rabat, Morocco
- Service d’Urgences et de Réanimation Médicale, Hôpital Ibn Sina, Rabat, Morocco.
Abdelkader Belkouchi, MD
- Surgery Department “A,” Ibn Sina Hospital, Rabat, Morocco

Received 7 September 2007; received in revised form 26 October 2007; accepted 20 November 2007. published online 28 January 2008.

Background

Operations are the mainstay of liver hydatid cyst (LHC) treatment. Operations are still associated with high morbidity and mortality because of specific postoperative complications (bile leaks, bilomas, deep bleeding, and deep suppurations) and deep abdominal complications (DAC). The aim of this study was to identify the predictive factors of DAC after LHC operation.

Study Design

We conducted a retrospective study of 672 patients with LHC treated at the Surgery Department “A” at Ibn Sina University Hospital, Rabat, Morocco. Specific morbidity (DAC) and 30 variables were assessed. Univariate and multivariate logistic regression were performed to identify predictive factors for DAC. An associated risk scoring system was developed.

Results

Six hundred sixty-four patients underwent operations. Mortality rate was 0.8% (n = 5) and DAC rate was 18.4% (n = 121). Five independent predictive factors of DAC after LHC operation were retained, ie, presence of cyst preoperative complications (odds ratio [OR] = 3.10; 95% CI, 1.85 to 5.17), 3 or more cysts in the liver (OR = 2.55; 95% CI, 1.42 to 4.59), thick pericyst (OR = 2.59; 95% CI, 1.27 to 5.29), biliary fistula (OR = 2.27; 95% CI, 1.38 to 3.72), and capitonnage alone as residual cavity management (OR = 2.23; 95% CI, 1.12 to 4.44). Multivariate model showed a good fit. Discriminating ability of the model was fair. In theoretical risk, scores ranged from 0 to 5. When the score was 2 or more, sensitivity of the scoring model was 80.3%, specificity was 58.5%, positive predictive value was 30.3%, and negative predictive value was 93%.