Parenchyma-Preserving Surgery in the Management of Pulmonary Hydatid Cysts

Abstract

Pulmonary hydatid cysts remain a significant health problem in endemic regions like Turkey. Here, we present our surgical experience in patients with pulmonary hydatid cysts. Between January 1985 and January 2001, 1118 operations were performed in 1032 patients (528 males, 504 females; mean age 32.7 years; range 1-87 years) with pulmonary hydatid cysts in our department. Posterolateral thoracotomy was performed in 1015 (98.3%), two-stage thoracotomy in 34 (3.3%), and median sternotomy in 17 (1.7%) patients. We preferred conservative surgical procedures. As a surgical procedure, cystotomy and capitonnage was performed in 626 (56%), cystotomy alone in 368 (33%), wedge resection in 81 (7%), enucleation in 29 (3%), and decortication in 11 (1%) patients. None of our patients were treated with anatomic resection. During surgery, 949 patients (92%) had unruptured and 83 patients (8%) had ruptured hydatid cyst. The morbidity ratio was 6.7%. Major complications were wound infection (2.3%), prolonged air leak (1.9%), atelectasis (1.2%), pleural effusion (0.8%), postoperative hemothorax (0.6%), and empyema (0.3%). Two patients (0.2%) died within the first month postoperatively. Mean follow-up was 31.2 months. Recurrence was detected in only 35 patients (3.3%). Treatment of pulmonary hydatid cyst is primarily surgical. Medical treatment is indicated for recurrent and multiple hydatid cysts postoperatively. Cystotomy alone, or cystotomy and capitonnage, as parenchyma-preserving surgery, is preferred. Radical surgery including pneumonectomy, lobectomy, and segmentectomy should be avoided.

Combined Procedure for Coronary Artery Bypass Grafting and Pulmonary Hydatid Disease

“…Rupture of pulmonary hydatid cyst is a serious complication. It can lead to pleural effusion, pleural empyema, pneumonitis and pulmonary abcess [2]. In the persistent of right pleural effusion that occurs after open heart surgery, hydatid cyst should be remembered especially in the endemic region [3].…”

“…There are always concerns of possible hydatid systemic dissemination as a result of direct vascular breach [2]. Rupture of pulmonary hydatid cyst is a serious complication.…”

“…The Clinical presentation of the hydatid disease depends upon the site of the cysts and their size [2]. Small cysts may remain asymptomatic indefinitely.…”

“…Diagnosis is made by a combination of clinical, imaging and serological tests. Surgery remains the mainstay of treatment [2].…”

“…Pulmonary hydatid disease occupies the third place among surgical thoracic diseases after lung cancer and mediastinal tumours [1]. The diagnosis of pulmonary hydatid cyst is an indication for surgery [2].…”