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

Ataturk University60 enrolled

Overview

This prospective comparative study evaluated two surgical techniques for residual cavity management following conservative surgery for complicated hepatic cystic echinococcosis. Patients undergoing surgery were managed with either omentoplasty or tube drainage. The study aimed to compare postoperative outcomes between the two techniques, with particular emphasis on postoperative complications and residual cavity-related complications. Long-term follow-up was also performed to assess recurrence and other clinical outcomes.

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.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Conditions

Hepatic Cystic Echinococcosis

Interventions

omentoplastyPROCEDURE

After conservative surgery for complicated hepatic cystic echinococcosis, the residual cavity was obliterated using a pedicled omental flap (omentoplasty) to reduce dead space and cavity-related complications.

External Tube DrainagePROCEDURE

After conservative surgery for complicated hepatic cystic echinococcosis, an external tube drain was placed into the residual cavity for postoperative drainage and monitoring.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

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.

Locations (1)

Atatürk University Faculty of Medicine

Erzurum, Erzurum, Turkey (Türkiye)

Outcomes

Primary Outcomes

Postoperative Residual Cavity-Related Complications

Incidence of postoperative complications related to the residual hepatic cyst cavity, including residual cavity infection, abscess formation, or other cavity-related complications, compared between the omentoplasty and tube drainage groups.

Time frame: Up to 30 days after surgery

Secondary Outcomes

Postoperative Bile Leakage

Incidence of postoperative bile leakage, defined as clinically evident biliary drainage after surgery, compared between the omentoplasty and tube drainage groups.

Time frame: Up to 30 days after surgery

Surgical Site Infection

Incidence of postoperative surgical site infection compared between the omentoplasty and tube drainage groups.

Time frame: Up to 30 days after surgery

Overall Postoperative Complications

Incidence of overall postoperative complications compared between the omentoplasty and tube drainage groups

Time frame: Up to 30 days after surgery

Operative Time

Duration of surgery from skin incision to completion of skin closure, compared between the omentoplasty and tube drainage groups

Time frame: During surgery

Recurrence of Hepatic Cystic Echinococcosis

Comparison of the incidence of hepatic cystic echinococcosis recurrence between the omentoplasty and tube drainage groups during long-term follow-up

Time frame: Up to at least 60 months after surgery

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.