Omentoplasty decreases deep organ space surgical site infection compared with external tube drainage after conservative surgery for hepatic cystic echinococcosis: Meta-analysis with a meta-regression

Introduction: The rate of deep organ space/surgical site infection after conservative surgery for hepatic cystic echinococcosis (HCE) ranges from 12% to 26% with a post-operative mortality rate between 0% and 7.5%. This systematic review with meta-analysis aimed to investigate whether omentoplasty (OP) following conservative surgery for HCE leads to decreased rates of morbidity and mortality compared to external tube drainage ETD. Patients and methods: We identified 4540 articles through database searching. After verifying the inclusion and exclusion criteria, we retained eight studies for final analysis: two randomized controlled trials (RCT), one prospective comparative study and five retrospective comparative studies. The main outcome measure was organ space/surgical site (OS/SS) morbidity that was limited to “deep organ space/surgical site infection (Deep OS/SSI) with or without re-operation”. Results: The eight studies reported results for deep OS/SSI (6/374 (OP) and 60/403 (ETD), respectively). There were statistically significantly less deep OS/SSI with OP (vs. ETD) OR = 0.17 95%CI [0.05, 0.62] (P = 0.007). A random-effect meta-regression, including the eight studies, showed an interaction in favor of OP. There were also statistically significant less biliary leakage ± fistula and overall morbidity in OP compared to ETD. On the other hand, no statistically significant difference was found concerning deep bleeding, mortality and recurrence between these two groups. Conclusion: This meta-analysis with a meta-regression showed that there were statistically significant less deep OS/SSI, biliary leakage ± fistula and overall morbidity in OP compared to ETD.