Pericystic-Digestive Anastomosis for Hepatic Hydatid Cysts: Indications Outcomes and a Surgical Decision Algorithm

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Pericystic-Digestive Anastomosis for Hepatic Hydatid Cysts: Indications Outcomes and a Surgical Decision Algorithm

Stere Popescu, Tina Popescu, Bogdan Obada, Teodor Ștefan Niţu, Irina Niţu, Maria Sabina Neacşu, Ana Maria Grigorescu, Florin Gabriel Pănculescu, Florin Daniel Enache, Mihai Victor Lupaşcu, Iulian Manac, Daniel Ovidiu Costea
Original article, no. 4, 2025
Article DOI: 10.21614/chirurgia.3159
Introduction: Pericystic-digestive anastomosis is a rarely used but valuable surgical option in the management of complicated hepatic hydatid cysts.

Materials and Methods: This retrospective observational study included 24 patients operated on between 2010 and 2023 in a general surgery center in Romania. We analyzed intraoperative decision-making, type of anastomosis, and postoperative outcomes.

Results: Roux-en-Y jejunostomy was performed in 19 patients, and pericystogastrostomy in 5. All patients had intraoperatively confirmed biliary fistulas â?¥5 mm. There were no deaths or reinterventions. Minor complications included transient febrile syndrome (12.5%), delayed bowel transit (8.3%), and one percutaneously drained subhepatic collection (4.1%). Follow-up imaging showed progressive reduction of residual cavities in all cases.

Conclusions: When correctly indicated, pericystic-digestive anastomosis provides safe and effective internal drainage for large, centrally located cysts with biliary fistulas and well-organized pericysts. Based on clinical experience and current literature, we propose a practical decision-making algorithm to guide surgical management in complicated hepatic echinococcosis.

Keywords: hepatic hydatid cyst, pericystic-digestive anastomosis, biliary fistula, Roux-en-Y jejunostomy surgical treatment, case selection, decision-making algorithm