Risk Factors and Strategies for Reducing Postoperative Complications in Hepatic Echinococcosis in an Endemic Region

Abstract

Hepatic echinococcosis remains a significant surgical problem in endemic regions and is associated with a high rate of postoperative complications, partly due to cyst-related anatomical features and insufficient consideration of metabolic and nutritional disorders. This study aimed to evaluate the effectiveness of an algorithm-based surgical strategy incorporating preoperative nutritional support and optimized residual cavity management.
A retrospective-prospective analysis included 246 patients with hepatic echinococcosis. The comparison group consisted of 127 patients treated using conventional surgical approaches, while 119 patients in the main group underwent an optimized diagnostic and therapeutic algorithm. Energy and nutritional status, postoperative complications, and long-term outcomes were assessed. Statistical analysis included Pearson's χ² test and multivariate logistic regression.
Most patients demonstrated significant preoperative energy and protein deficiency, with actual intake reaching only 70–80% of physiological requirements. In the main group, the overall postoperative complication rate decreased from 27.6% to 6.7% (p<0.001), with no postoperative mortality observed. No disease recurrence was detected during long-term follow-up.
An algorithm-based surgical approach combined with mandatory preoperative nutritional optimization and standardized residual cavity management is an effective and safe strategy for improving short- and long-term outcomes in patients with hepatic echinococcosis.