Myoplasty versus omentoplasty in the surgical treatment of hydatidosis of the liver dome

Even though surgery is the mainstay in the management of hydatid disease of the liver, controversies still exist about the preferred operating technique. This study was conducted to evaluate myoplasty versus omentoplasty for the surgical treatment of hepatic dome hydatidosis.

Sixty-two patients with a hydatid cyst located over the right superior–posterior part of the liver or a cyst adherent to the right hemidiaphragm were classified into two groups according to the type of surgical approach. Group A comprised 50 patients who had undergone thoracoabdominal, right subcostal, or right paramedian incision. Group B comprised 12 patients who had undergone posterior–lateral thoracotomy. Twenty-four patients with a right thoracoabdominal incision underwent partial excision of the cyst with omentoplasty (18 patients), external drainage (four patients), and marsupialization (two patients).

Twenty-six patients with a right subcostal or paramedian incision underwent partial resection of the cyst with omentoplasty (15 patients), external drainage (eight patients), and combination of procedures (three patients). Twelve patients that had undergone a right thoracotomy underwent partial excision of the cyst wall with myoplasty of the right hemidiaphragm. Surgical approaches such as thoracoabdominal, right subcostal, or paramedian incision were associated with higher morbidity rate than thoracotomy alone (P<0.03). In addition, patients with myoplasty of the right hemidiaphragm were associated with a lower morbidity rate than those with omentoplasty (P<0.02). Five patients had recurrent disease and were reoperated upon. Partial cystectomy and myoplasty of the right hemidiaphragm was performed with excellent results.

These results suggest that a thoracic approach, with myoplasty of the right hemidiaphragm and high-vacuum drainage, might produce low complication and recurrence rates and the best clinical results. Consequently, it is a promising procedure that requires more application and evaluation.