{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:09:30Z","timestamp":1789132170759,"version":"build-2803163510"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatic hydatid cyst (HHC) remains a significant public health challenge in endemic regions, causing substantial morbidity and placing a persistent burden on healthcare systems. While surgery is the primary therapeutic intervention, the high rate of specific postoperative complications, particularly biliary fistulas, necessitates a more strategic approach to clinical risk management and patient stratification to optimize resource utilization. This study aims to identify predictive factors for postoperative complications to guide clinical decision-making and enhance the efficiency of surgical care in endemic settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 107 patients (168 cysts) who underwent surgery for HHC at the Ibn Al Jazzar University Hospital, Kairouan, over an 8-year period (2017\u20132025). We analyzed a comprehensive set of clinical, biological, and radiological data using univariate and multivariate binary logistic regression models to isolate independent predictors of specific postoperative morbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Conservative surgical management was employed in 89.7% of patients. The overall postoperative complication rate was 15.9%, with biliary fistula identified as the most frequent specific complication (7.5%). Multivariate analysis confirmed that suspected complications on preoperative CT scans (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.03) and the presence of intraoperative complications (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01) were independent, significant predictive factors for specific postoperative morbidity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative CT imaging is a robust, non-invasive triage tool for identifying high-risk patients, which is critical for health system sustainability. Integrating these predictive markers into clinical protocols will allow for optimized surgical planning, reduced hospital resource consumption, and the mitigation of the public health burden associated with HHC in endemic regions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1926824","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:40:15Z","timestamp":1788417615000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A public health approach to optimizing surgical outcomes for hepatic hydatid cyst: identifying predictive factors for postoperative morbidity"],"prefix":"10.3389","volume":"14","author":[{"given":"Jihen","family":"Krichen","sequence":"first","affiliation":[{"name":"Digestive and Visceral Surgery Department, Aghlabides Surgical Unit, Ibn Aljazzar Hospital","place":["Kairouan, Tunisia"]},{"name":"Faculty of Medicine of Sousse, University of Sousse","place":["Sousse, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma","family":"Sghaier","sequence":"additional","affiliation":[{"name":"Digestive and Visceral Surgery Department, Farhat Hached University Hospital","place":["Sousse, Tunisia"]},{"name":"Faculty of Medicine of Sousse, University of Sousse","place":["Sousse, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maissa","family":"Timoumi","sequence":"additional","affiliation":[{"name":"Digestive and Visceral Surgery Department, Aghlabides Surgical Unit, Ibn Aljazzar Hospital","place":["Kairouan, Tunisia"]},{"name":"Faculty of Medicine of Sousse, University of Sousse","place":["Sousse, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saif","family":"Farhaoui","sequence":"additional","affiliation":[{"name":"Digestive and Visceral Surgery Department, Aghlabides Surgical Unit, Ibn Aljazzar Hospital","place":["Kairouan, Tunisia"]},{"name":"Faculty of Medicine of Sousse, University of Sousse","place":["Sousse, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sihem","family":"Sindi","sequence":"additional","affiliation":[{"name":"Digestive and Visceral Surgery Department, Aghlabides Surgical Unit, Ibn Aljazzar Hospital","place":["Kairouan, Tunisia"]},{"name":"Faculty of Medicine of Sousse, University of Sousse","place":["Sousse, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilel","family":"Faidi","sequence":"additional","affiliation":[{"name":"Digestive and Visceral Surgery Department, Aghlabides Surgical Unit, Ibn Aljazzar Hospital","place":["Kairouan, Tunisia"]},{"name":"Faculty of Medicine of Sousse, University of Sousse","place":["Sousse, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalil","family":"Ben Salah","sequence":"additional","affiliation":[{"name":"Digestive and Visceral Surgery Department, Aghlabides Surgical Unit, Ibn Aljazzar Hospital","place":["Kairouan, Tunisia"]},{"name":"Faculty of Medicine of Sousse, University of Sousse","place":["Sousse, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajer","family":"Hannachi","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Ibn Aljazzar University Hospital","place":["Kairouan, Tunisia"]},{"name":"Faculty of Medicine of Sousse, University of Sousse","place":["Sousse, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Latifa","family":"Merzougui","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Ibn Aljazzar University Hospital","place":["Kairouan, Tunisia"]},{"name":"Faculty of Medicine of Sousse, University of Sousse","place":["Sousse, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/S1773-035X(17)30116-8","article-title":"Le kyste hydatique du foie","volume":"2017","author":"Wejih","year":"2017","journal-title":"Rev Fr Lab"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e211","DOI":"10.1016\/j.jviscsurg.2011.05.009","article-title":"Hydatid cyst open in biliary tract: therapeutic approaches. Report of 22 cases","volume":"148","author":"Baraket","year":"2011","journal-title":"J Visc Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/S0246-0424(13)60295-2","article-title":"Traitement chirurgical des kystes hydatiques du foie","volume":"8","author":"Noomen","year":"2013","journal-title":"EMC Tech Chir App Dig"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1007\/s002680020005","article-title":"Management of liver hydatid cysts with a large biliocystic fistula: multicenter retrospective study","volume":"25","author":"Abdelj\u00e9lil Zaouche","year":"2001","journal-title":"World J Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1186\/s12893-022-01570-7","article-title":"Postoperative morbidity risk factors after conservative surgery of hydatic cyst of the liver: a retrospective study of 151 hydatic cysts of the liver","volume":"22","author":"Ghannouchi","year":"2022","journal-title":"BMC Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/S0001-706X(02)00224-1","article-title":"International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings","volume":"85","year":"2003","journal-title":"Acta Trop"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1016\/S0003-3944(01)00507-7","article-title":"Les kystes hydatiques du foie rompus dans les voies biliaires. \u00c0 propos de 64 cas","volume":"126","author":"Daali","year":"2001","journal-title":"Ann Chir"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"355","DOI":"10.3748\/wjg.v19.i3.355","article-title":"Biliary fistula after treatment for hydatid disease of the liver: when to intervene","volume":"19","author":"Zeybek","year":"2013","journal-title":"WJG."},{"key":"ref9","first-page":"9","volume-title":"Le kyste hydatique du foie. 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