percutaneous management of cystobiliary fistulas by small catheters

Objectives: this study aims to use mean volume of fluid, which is drained from a liver hydatid cyst with cystobiliary fistula developing after percutaneous treatment, for determining the type of treatment as surgery versus conservative. patients and methods: the cohort data was collected retrospectively from 10 out of 90 hydatid cysts in 10 out of 65 patients treated percutaneously with needle and catheterization methods. groups were defined as surgical and conservative. the mean volumes until the 20th day after detection of the biliary fistula were used. in addition, the mean volumes until the 20th day of 42 catheterization patients without biliary fistula were used as controls for quantitative analysis. results: all 10 cysts with cystobiliary fistulas were managed with small (8 f) catheters. all patients in the conservative group had < 211 ml/day mean drainage for the 20 days. for the patients that developed cystobiliary fistulas of liver hydatid disease, 30% required surgical treatment. after receiver operating characteristic (roc) curve analysis, the cut-off value for success of hydatid cyst treatment was 206 ml/day of drained content. conclusion: to reduce superfluous costs and time, cystobiliary fistula with < 206 ml/day mean drainage until the 20th day may be efficiently treated with percutaneous drainage using small catheters.