Omentoplasty Versus Tube Drainage for Residual Cavity Management in Complicated Hepatic Cystic Echinococcosis

Cystic echinococcosis of the liver may be associated with complications such as biliary communication, infection, rupture, cholangitis, and involvement of adjacent structures. Following conservative surgical treatment, appropriate management of the residual hepatic cavity remains an important component of surgical care.

This prospective, single-center comparative study was conducted at Atatürk University Faculty of Medicine and included adult patients undergoing conservative surgery for complicated hepatic cystic echinococcosis. Eligible patients were allocated to residual cavity management with either omentoplasty or tube drainage according to a predetermined alternating allocation strategy.

The study was designed to compare the clinical outcomes of these two residual cavity management techniques. Postoperative outcomes included overall postoperative complications, surgical site infection, biliary fistula, and residual cavity-related complications. Operative characteristics and other relevant perioperative outcomes were also evaluated.

All surgical procedures were performed by the same surgical team using a standardized perioperative approach. Patients received albendazole treatment according to the institutional treatment protocol. Following surgery, patients underwent clinical and radiological follow-up using ultrasonography and/or computed tomography as clinically appropriate. Long-term follow-up was used to evaluate recurrence and other relevant clinical outcomes.

The primary objective of the study was to determine whether the method used for residual cavity management was associated with differences in postoperative outcomes after conservative surgery for complicated hepatic cystic echinococcosis.

Inclusion criteria

• Age 18-80 years.
• Complicated hepatic cystic echinococcosis requiring surgical treatment.
• Cyst diameter ≥8 cm.
• Cysts located in hepatic segments IV, V, VI, VII, or VIII.
• WHO-IWGE CE2 or CE3b cyst stage.
• Presence of at least one complication or high-risk feature, including rupture, adjacent organ involvement, cholangitis, biliary communication, or cyst infection.
• ASA physical status ≤III.

Exclusion criteria

• WHO-IWGE CE1 or CE3a cyst stage.
• Cysts located in hepatic segments I, II, or III.
• Extensive multiple hepatic cysts.
• Previous surgery for hepatic cystic echinococcosis.
• Malignancy.
• Pregnancy.
• ASA physical status >III.