Omentoplasty Versus Tube Drainage After Conservative Surgery for Hepatic Cystic Echinococcosis at High Risk of Biliary Complications: A Prospective Comparative Study

Background/Objectives: Residual cavity complications contribute to morbidity after conservative surgery for hepatic cystic echinococcosis (HCE). We compared omentoplasty and tube drainage in patients with HCE at high risk of biliary complications. Methods: This prospective, single-center, nonrandomized study included 60 patients allocated alternately to omentoplasty or tube drainage (30 per group). The primary outcome was bile leakage and/or residual cavity complications within 30 days after surgery. Exploratory Firth logistic regression adjusted for cyst diameter and preoperative cholangitis. Holm correction was applied to five secondary outcomes. Results: The primary outcome occurred in 6/30 (20.0%) versus 16/30 (53.3%) patients (risk ratio 0.375; 95% confidence interval [CI] 0.170–0.826; p = 0.015). Adjusted odds were higher with tube drainage (odds ratio 5.25; 95% CI 1.51–22.72; p = 0.008). This association persisted after additional adjustment for preoperative endoscopic retrograde cholangiopancreatography. Surgical site infection (3.3% vs. 30.0%) and percutaneous intervention (0% vs. 26.7%) were less frequent with omentoplasty (Holm-adjusted p = 0.049 and 0.023, respectively). The operative-time difference was not significant after Holm adjustment. Bile leakage occurred in 20.0% versus 36.7% (p = 0.252). Mean follow-up was 68.8 ± 5.8 months; all patients completed at least 60 months, with no loss to follow-up. Recurrence occurred in 3.3% versus 13.3% (p = 0.353). Conclusions: Omentoplasty was associated with a lower incidence of the composite outcome, including after adjustment. These findings support its use in suitable patients and warrant confirmation in larger randomized studies.