TITRE: Viability predictive factors of the daughter vesicles in hepatic hydatid cyst

Introduction: Management of hepatic hydatidosis requires knowledge of certain aspects related to the survival of Echinococcus granulosus. The viability of daughter vesicles (DV) is a determining factor in guiding therapeutic indications, particularly for transiently active Cysts type CE3b. Purpose: To determine the predictive factors of DV viability and its impact on the therapeutic management of CE3b type. Materials: and Methods This is a prospective pilot study with analytical aim on patients with hydatid cysts of the liver type CE2 and CE3b, operated in the General Surgery Department of Habib-Bourguiba Academic Hospital, Sfax-Tunisia during 22 months from March 2018 until December 2019. The unit of the study is the DV. A parasitological study of the DV was done in the parasitology laboratory. Results: During the study period, 27 (40.9%) of 66 operated Cystic Hydatid Disease from 21 patients containing 248 DV were explored. The median viability of DV protoscoleces was 16.7%. In bivariate analysis, factors for viability of DV protoscoleces were: fever, acute cholangitis, hyperbilirubinemia, left liver location, rock water and bilious hydatid fluid (HF), cyst size ≥ 43mm, intracystic pressure ≥ 35 mmHg, DV size ≥ 6.5mm, volume, number of DV/cyst ≥ 5, and opaque wall (p < 0.05). Predictive factors for Non-viability of DV were: CE3b type, purulent HF and gelatinous HF. In multivariate analysis, only CE2 type, cyst size ≥ 43 mm, number of DV/cyst ≥ 5 and DV size ≥ 6.5 mm were factors significantly associated with the viability of DV protoscoleces. Conclusion: CE3b cysts without the criteria of viability of DV protoscoleces may become candidates for 'Wait-and-Watch' procedure.