Predictors of cystobiliary communication in patients undergoing surgery for hepatic hydatid cysts.

Cystobiliary communication (CBC) is a common complication of hepatic hydatid cysts, increasing surgical complexity and postoperative morbidity. Reliable preoperative prediction and intraoperative detection of occult CBC remain challenging. We retrospectively analyzed 106 patients undergoing surgery for hepatic hydatid disease. Patients were classified as CBC or non-CBC based on intraoperative findings. Clinical, laboratory, radiologic, and operative variables were evaluated. Multivariate logistic regression identified independent predictors, and Receiver Operating Characteristic (ROC) analysis determined optimal cut-offs. Subgroup analysis compared occult and frank CBC. CBC occurred in 42% of patients (16% frank, 26% occult). Multivariate analysis revealed cyst size (OR 1.29; 95% CI 1.07-1.56; p = 0.007) and direct bilirubin (OR 16.35; 95% CI 2.60-102.3; p = 0.003) as independent predictors. ROC analysis suggested thresholds of ≥ 8.85 cm for cyst size and ≥ 0.7 mg/dL for direct bilirubin. Occult CBC accounted for 26% of cases; despite intraoperative provocation tests and saline/dye injection, 25% developed high-output postoperative bile fistula, some requiring ERCP. Subgroup analysis indicated that frank CBC was associated with larger cysts, higher cholangitis rates, and more frequent intrahepatic bile duct dilatation, but postoperative outcomes were comparable. Cyst size and direct bilirubin are independently associated with CBC. Intraoperative provocation tests cannot fully exclude occult communication; vigilant postoperative monitoring and proactive biliary management are essential for high-risk patients.