Abstract
PURPOSE: Hydatid cysts, caused by Echinococcus species, represent a significant global health issue, particularly in endemic regions. Hepatic hydatid cysts may result in cystobiliary fistulas in 2-42% of cases, complicating treatment and leading to prolonged hospital stays and increased costs. This study aims to identify risk factors for cystobiliary fistula formation and evaluate outcomes in pediatric patients. METHODS: We conducted a retrospective study involving 53 pediatric patients treated for hepatic hydatid cysts between 2002 and 2016. Patients were divided into two groups: the Fistula-Positive (FP Group, n = 15) and the Fistula-Negative (FN Group, n = 38). Cysts were classified as Fistulous Cysts (FC Group, n = 23) or Non-Fistulous Cysts (NFC Group, n = 92). We analyzed data regarding demographics, cyst characteristics, management, and outcomes. RESULTS: Larger cyst size was significantly linked to the formation of cystobiliary fistulas (p = 0.040). Fistulous cysts had a median diameter of 100 mm, compared to 80 mm for non-fistulous cysts. Other factors, such as patient age, gender, residence, and cyst type, did not show a significant association. Patients with fistulas had a more extended hospital stay (median: 32 days vs. 7 days, p < 0.0001). CONCLUSIONS: A larger cyst size significantly predicted cystobiliary fistulas in hepatic hydatid disease. Proactive management, including advanced imaging, intraoperative techniques, and multidisciplinary care, is crucial for improving patient outcomes and minimizing complications of hepatic hydatid cysts, including cystobiliary fistulas.