Omentoplasty in the prevention of deep abdominal complications after surgery for hydatid disease of the liver: A multicenter, prospective, randomizedtrial

Background: Omentoplasty (OP) is thought to fill residual cavity, to assist healing of raw surfaces, and to promote resorption of serosal fluid and ma crophagic migration in septic Foci. Results published to date, whether retr ospective or prospective, are not controlled and are discordant. Study Design: The authors investigated whether OI: either filling the resid ual cavity after unroofing, or covering the hepatic raw surface after peric ystectomy, could reduce the rate or severity of deep abdominal complication s (DAC) after surgical treatment of hydatid disease of the liver. Between J anuary 1993 and December 1996, 115 consecutive patients (51 males and 64 fe males, mean age 42 +/- 16 years [range 10 to 80 years]) with previously uno perated uni- or muitilocular hydatid disease of the liver, complicated or n ot, without other abdominal hydatid disease, were randomly allotted to OP ( n = 58) or not (NO) (n = 57) after unroofing, total, or partial pericystect omy. Patients were divided into 2 strata according to the site of the cyst with respect to the diaphragm: a) posterosuperior segments II, VII, and VII I or b) anterior segments III, IV, V, and VI. Main outcomes measures included deep bleeding, hematoma, infection, or bile leakage. Subsidiary measures included wound complications, extraabdominal complications, duration of operation, and length of hospital stay. Results: Both groups were comparable regarding patient demographics, cyst c haracteristics, intraoperative procedures, search for bile leaks, and intra operative transfusion requirements. On the other hand, more patients (86%) in NO had associated drainage of the abdominal cavity than in OP (64%) and the duration of operation was 9 minutes longer in OF, but neither of these differences was statistically significant. Less DAC occurred in OP (10%) th an in NO (23%) (a posteriori gamma risk < 0.05) and fewer deep abdominal ab scesses (0 versus 11%) (p < 0.03). Median duration of hospital stay, howeve r, was similar. Conclusions: OP decreases the rate of DAC and especially deep abdominal abs cess after surgical treatment (unroofing or pericystectomy) for hydatid dis ease of the liver and should be recommended in this setting. (J Am Coll Sur g 1999;188:281-289. (C) 1333 by the American College of Surgeons).