Prognostic risk factors for suppuration of the residual liver cavity after echinococcectomy

Objective: to identify the most significant risk factors for suppuration of the residual liver cavity after echinococcectomy.

Material and methods: a retrospective cohort analysis included 122 patients who underwent surgery for hepatic echinococcosis between 2020 and 2026. The study group comprised 58 patients with residual cavity (RC) suppuration; the control group comprised 64 patients without this complication. The following parameters were analysed: type of surgical intervention, cyst dimensions, presence of cystobiliary fistulas, quality of RC treatment, and drainage parameters. IBM SPSS Statistics 22.0 was used for statistical analysis that employed the following methods: Pearson’s chi-square test, Fisher’s exact test, and odds ratio (OR) with 95% confidence intervals (CI).

Results: RC suppuration most frequently occurred after open echinococcectomy (72.4%). The most significant risk factors were large and giant echinococcal cysts (>10 cm) (OR=37.96; 95% CI 4.86–296.48; p <0.001), inadequate RC treatment with scolicidal solutions (OR=6.18; 95% CI 2.78–13.75; p <0.001), inadequate drainage (OR=5.90; 95%CI 2.46–14.16; p <0.001), and early drainage tube removal (OR=5.84; 95% CI 2.57–13.28; p <0.001). In 79.3% of cases, RC suppuration required repeat intervention.

Conclusion: the study showed that the leading modifiable risk factors for RC suppuration are deficiencies in surgical technique: inadequate cavity management (sanitization) and drainage. Large and giant cysts substantially increase the risk of purulent complications and require particular attention during surgical planning.

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