Prevention of Biliary Leaks by Biliary Drainage after Hydatid Liver Surgery

I did not understand the reason of routine cholecystectomy in hydatid liver surgery and lastly, the term of ‘anti-scolicidal’ is, I think, a misprint. Thank you very much. Dear Sir, I read with great interest the article about the surgical treatment of hydatid disease of the liver by Silva et al. [1] , and I thank them for their study. They reported 50% cystobiliary communication rates in hydatid liver cysts, and their study recommended biliary system drainage in those cases. I completely agree with the authors that the rates of cystobiliary communications in the literature are underreported, and we found a rate of 37% [2] . However, I am worried about the routine biliary drainage that may increase postoperative morbidity and hospital stay. Obliteration of the cavity (especially by omentoplasty) is a good alternative for prevention of postoperative biliary complications [3, 4] . In the past, we preferred biliary drainage only in the cases of common bile duct exploration for hydatid jaundice [5] . Nowadays, this procedure has decreased with the opportunity of using preoperative endoscopic retrograde cholangiopancreatography as well. I believe that routine biliary drainage may be an aggressive approach for the hydatid liver cysts with cystobiliary communication. The second point is using methylene blue for the detection of cystobiliary communications. In an experimental study in rats, we compared the effects of vital dyes (methylene blue and fl uorescein) with normal saline on hepatobiliary system and found better liver function tests and histopathological results with normal saline and fl uorescein than methylene blue [6] . I prefer normal saline instead of vital dyes for detection of cystobiliary communications through the common bile duct. Dyes also have the disadvantage of coloring the surgical area that make it diffi cult to identify the biliary orifi ce, and especially if there is more than one orifi ce. Published online: January 16, 2006