To evaluate the application value of precise liver surgery combined with enhanced recovery after surgery (ERAS) concept in surgical treatment of complex hepatic cystic echinococcosis.

Clinical data of 42 patients with complex hepatic cystic echinococcosis who underwent surgery in People's Hospital of Xinjiang Uygur Autonomous Region from January 2012 to January 2021 were retrospectively studied. Among them, 23 patients were male and 19 female, aged from 23 to 61 years, witha median age of 39 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the traditional surgery group (traditional group, n=23) and precise surgery combined with ERAS group (combination group, n=19) according to different perioperative management patterns. Perioperative conditions, postoperative complications and clinical efficacy were compared between two groups. The operation time, intraoperative blood loss and other data were statistically compared with t test or rank-sum test. The incidence of postoperative complications was assessed by Chi-square test.

No perioperative death occurred. All patients in the combination group were evaluated by 3D reconstruction before surgery. Surgical approach was consistent with the evaluation results. In the combination group, the median intraoperative blood loss and postoperative liver function recovery time were 200(900) ml and 3(4) d, significantly less than 400(850) ml and 4(10) d in the traditional group (Z=-2.74, -2.25; P<0.05). In the combination group, the average operation time, postoperative anal exhaust time, postoperative feeding time, abdominal drainage catheter indwelling time and length of postoperative hospital stay were (182±25) min, (17.2±3.0) h, (18.6±3.8) h, (3.0±1.0) d and (6.0±2.0) d, significantly less compared with (204±31) min, (20.4±2.4) h, (22.7±3.2) h, (5.0±1.0) d and (8.0±1.0) d in the traditional group (t=-2.51, -3.88, -3.78, -4.14, -2.55; P<0.05). In the combination group, the incidence of postoperative complications was 26%(5/19), significantly lower than 57%(13/23) in the traditional group (χ²=3.88, P<0.05).

Precise liver surgery combined with ERAS concept can reduce the intraoperative blood loss, lower the incidence of postoperative complications, enhance postoperative recovery and effectively improve surgical efficacy for complex hepatic cystic echinococcosis.