Single-Stage VATS and Thoracotomy in Multiple Organ Hydatidosis

Abstract

We report a case of hydatidosis of the bilateral lung and of the left lobe of the liver which we treated by cystotomy and capitonnage via right video-assisted thoracoscopy, left posterolateral thoracotomy, and diaphragm incision in a single-stage operation. The patient developed a right pleural infection in the ninth postoperative month and underwent exploratory thoracotomy and recapitonnage. Thoracoscopic cyst extirpation can be safely performed alone or in combination with thoracotomy to reduce the operative inconvenience for patients.

Single-Stage Transthoracic Surgery of Right Pulmonary and Hepatic Hydatid Cysts: A Retrospective Study of Fourteen Patients

“…The synchronous right pulmonary and sub-diaphragmatic hepatic cysts can be managed through several approach [13,15]. Two-stage posterolateral thoracotomy and laparotomy (lung surgery first except if the hepatic cyst is complicated or >10 cm in diameter); it is the procedure that we used prior to 2009 [6] but it is responsible for more morbidity, pain, longer stay and higher costs [14,16,17].…”

“…We do not recommend video-assisted thoracoscopic surgery (VATS) because the removal of the cystic membrane is possible but there is a high risk of spillage of cyst contents (fluid and scolices) with pleural dissemination, empyema, and anaphylactic shock. Single-stage can be used to achieve combined resection via a right posterolateral thoracotomy [5][6][7][8][9][10][11][12]. Goyal et al [18] believe that single-stage using the transdiaphragmatic approach reduces the diaphragmatic function, increases spread of infection, bile leakage, and cross contamination through the phrenotomy.…”

“…For the hepatic location, excessive bile leakage; subphrenic abscess, parietal infection, cutaneous fistula, cholangitis, and septicemia can occur [4,6,8,9,11,15]. Some authors suggest pre-operative medical treatment to reduce the tension in the cyst and decrease the risk of spillage [1,3,6]; this treatment is used at least two weeks before surgery except in emergency situations. Other authors do not use preoperative treatment because it is thought to cause retention of membranes with a risk of re-occurrence [2].…”

“…Surgical treatment was through a posterolateral thoracotomy [1,2,[5][6][7][8][9][10][11][12]. The first step is treatment of the pulmonary cyst.…”

Concomitant Intrathoracic Extrapulmonal and Cervical Hydatid Cyst—a 10-Year Follow-up

“…To our knowledge, this is the first report of an intrathoracic extrapulmonary hydatidosis at the apex of the thoracic cavity removed by VATS. Treatment of pulmonary hydatidosis with VATS has become more popular in the past years with promising results [7] although VATS echinococcectomy was considered a contraindication at the beginning of the 1990s [8]. Findikcioglu et al published a case series including three mediastinal cases removed by VATS [3].…”