Hepatic Cystic Echinococcosis
Conditions
Keywords
Cystic Echinococcosis, Hydatid Cyst, Liver, Omentoplasty, Tube Drainage, Residual Cavity, Conservative Surgery, Biliary Fistula
Brief summary
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.
Detailed description
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.
Interventions
PROCEDUREomentoplasty
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.
PROCEDUREExternal Tube Drainage
After conservative surgery for complicated hepatic cystic echinococcosis, an external tube drain was placed into the residual cavity for postoperative drainage and monitoring.
Sponsors
Ataturk University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Participants were assigned to two parallel groups undergoing either omentoplasty or tube drainage for residual cavity management following conservative surgery for complicated hepatic cystic echinococcosis.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Residual Cavity-Related Complications | Up to 30 days after surgery | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Bile Leakage | Up to 30 days after surgery | Incidence of postoperative bile leakage, defined as clinically evident biliary drainage after surgery, compared between the omentoplasty and tube drainage groups. |
| Surgical Site Infection | Up to 30 days after surgery | Incidence of postoperative surgical site infection compared between the omentoplasty and tube drainage groups. |
| Overall Postoperative Complications | Up to 30 days after surgery | Incidence of overall postoperative complications compared between the omentoplasty and tube drainage groups |
| Operative Time | During surgery | Duration of surgery from skin incision to completion of skin closure, compared between the omentoplasty and tube drainage groups |
| Recurrence of Hepatic Cystic Echinococcosis | Up to at least 60 months after surgery | Comparison of the incidence of hepatic cystic echinococcosis recurrence between the omentoplasty and tube drainage groups during long-term follow-up |
Countries
Turkey (Türkiye)
Outcome results
None listed