Bilateral staged thoracotomy for multiple lung hydatidosis

Abstract

BackgroundHydatid cyst disease is still a problem in many countries. Surgical removal is currently the generally accepted choice of treatment for lung hydatidosis. However, operating on bilateral widespread lung hydatidosis is still controversial. The aim of this retrospective study was to evaluate the results of surgical treatment in bilateral multiple hydatid disease of the lung.MethodsIn this study, we reviewed our experience in the surgical treatment of 17 (3.7%) patients with bilateral, and at least three, lung hydatid cysts. These 17 patients (8 male, 9 female), with an average age of 34.6 years (range 12–58 years), underwent bilateral staged thoracotomy.ResultsIn total 105 lung cysts were removed from 17 patients who underwent staged thoracotomies. The mean count of cysts was 6.7 (range 3–20 cysts). Most of the cysts (38.2%) were located in the right lower lobe. The mean interval between thoracotomies was 4.2 (range 3–5) days. Two patients (11.7%) had cysts associated with hepatic hydatidosis and one (5.8%) had cysts associated with the spleen; they were treated via phrenotomy during thoracotomies. All cysts were removed without lung resection. We observed some complications such as prolonged air leaks (n = 2), atelectasis (n = 3) and empyema (n = 2). No further surgery was required for management of complications. The mean hospital stay was 9.3 days. (range 7–23 days). Oral albendazole was started on the 2nd post operative day after the first thoracotomy in the dose of 10–20 mg/kg and was continued for 3 months with a gap of 1 week after each 21 days. No recurrences or deaths occured during the follow-up period.ConclusionsAlthough staged thoracotomy applied in 3–5 days after the initial thoracotomy increases the total hospital stay, it decreases the chance of possible complications can occur in cysts in the other lung when long intervals are preferred between the first and the second thoracotomy. In our experience, bilateral staged thoracotomy is an appropriate surgical option because morbidity rates are minimal and the hospital stay is acceptable for the treatment of bilateral widespread lung hydatidosis, even in patients who had a total of 20 hydatid cysts.

Is Anatomic Lung Resection Necessary in Surgical Treatment of Giant Lung Hydatid Cysts in Childhood?

“…Some authors including us support this opinion because of the high healing capacity of the lung in children. 12,15,19) In the literature, postoperative complication rates in patients who underwent lung resection for hydatid cysts were reported as wound site infection 19.4%, pneumonia 11.1%, atelectasis 8.3%, empyema 8.3%, prolonged air leakage 5.5%, drainage requiring revision 5.5%, and aseptic space 5.5%. 14) In our study, the most common postoperative complication was atelectasis.…”

“…[7][8][9] Some authors pointed out the indications for lung resection as the invasion of more than 50% of the lobe by cyst or presence of multiple cysts in the same lobe. [8][9][10][11][12] This indications increase the resection rates very severely. In pediatric patients, the sizes of lung lobes are smaller than adults.…”

Bilateral pulmonary hydatidosis associated with uncommon muscular localization

“…Pulmonary hydatidosis has a unilateral localisation commonly. The bilateral involvement is unfrequent with a prevalence ranging from 4% to 26.7% in endemic regions [ 7 ].…”

Single-center experience in the surgical treatment of combined lung Echinococcosis

“…The method provides extra strength of lung parenchyma and prevents subsequent dissemination through air and formation of empyema. 17 , 18 …”