Cystobiliary communication in liver hydatid disease: 60 years of experience at a national referral center with more than 1500 patients

Background: Cystobiliary communication (CBC) is the most common complication of liver hydatid disease (LHD). This study aimed to analyze operative management and outcomes in surgically treated patients and identify predictors of CBC. Methods: A prospectively maintained single-center database (January 1963–June 2025), consisting of 1507 consecutive patients who underwent surgery for LHD, was retrospectively analyzed. Patients were divided into two groups based on whether they had CBC. Multivariate logistic regression was used to identify independent predictors of CBC. Results: CBC was identified in 309 patients, corresponding to a prevalence of 20.5% within the study cohort. The patients in the CBC group were younger than those in the non-CBC group (median age: 44 vs. 47 years; P = 0.003) and had larger cysts (10 vs. 8 cm; P < 0.001). Jaundice, cholangitis, fever ( P < 0.001), and leukocytosis ( P < 0.01) were more frequent in the patients with CBC. Conservative surgery (partial pericystectomy) was performed in most patients with LHD (CBC/non-CBC: 85% vs. 90%; P = 0.067). The multivariate analysis identified several predictors of CBC: younger age [odds ratio (OR) = 0.985 per year; 95% confidence interval (CI): 0.977–0.995; P = 0.002], larger cyst diameter (OR = 1.071 per cm; 95% CI: 1.029–1.114; P < 0.001), fever (OR = 1.56; 95% CI: 1.05–2.33; P = 0.029), jaundice (OR = 2.01; 95% CI: 1.12–3.60; P = 0.019), leukocytosis (OR = 1.48; 95% CI: 1.10–1.99; P = 0.010), and contralateral lobe hypertrophy (OR = 1.51; 95% CI: 1.02–2.22; P = 0.038). Conclusion: Conservative surgery was the operative modality for most patients. Beyond the established predictors for CBC, fever, jaundice, leukocytosis, and contralateral lobe hypertrophy emerged as independent risk factors.