Surgical treatment of pulmonary hydatid cysts in children

PURPOSE: Ten years' experience is analyzed in pediatric patients with pulmonary hydatid cysts. METHODS: Between 1990 and 2000, 33 pediatric patients (2 to 15 years of age) with pulmonary hydatid cysts were operated on in Department of Thoracic Surgery in Ankara University School of Medicine. There were 17 girls and 16 boys. RESULTS: Twenty-three cases presented as a solitary lung cyst, whereas the remaining 10 were found to have multiple cysts in one or both lungs. Cystotomy and capitonnage were performed in 25 patients, cystotomy was done in 6 patients, and only 2 patients underwent the wedge resection. The authors used no scoliocidal agent in our approach. There was no operative mortality. Recurrence after operation was seen in one patient. CONCLUSION: Pulmonary hydatid cysts in children can be treated successfully by cystotomy and capitonnage or only cystotomy. J Pediatr Surg 36:917-920.     

Parenchyma-Preserving Surgery in the Management of Pulmonary Hydatid Cysts

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.     

Parenchyma-preserving surgery in the management of pulmonary hydatid cysts.

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.     

One-stage operation via median sternotomy and phrenotomy for bilateral lung and liver hydatid disease

Background Echinoccosis is an endemic disease throughout the world. We reviewed a series of 26 bilateral lung and liver hydatid treated surgically via median sternotomy and either phrenotomy or laparotomy. Aims This study was conducted to emphasize the importance of one-stage operation via median sternotomy for multiple hydatid cysts. Materials and Methods This study is a retrospective review of our surgical skills for treatment of hydatid cysts. From January 1990 to January 2001, 173 patients were operated for hydatid disease in Heybeliada Thoracic Surgery Center. Twenty-six (15%) of them had bilateral lung hydatid cysts including 17 concomitant liver cysts. Median sternotomy was performed in all of 26 cases and phrenotomy was commonly used to remove concomitant liver cysts at the same operation. Cystotomy without capitonnage was the most common operative procedure for both lung and liver cysts. Results There was no operative and postoperative death. Post-operative complications occurred in only two patients: these were atelectasis and wound infection. The mean follow-up was 7.3 years (ranging from 1 to 12 years). No recurrence was recorded both in lung and in liver. Conclusions One-stage operation using median sternotomy and phrenotomy should be preferred to stage thoracotomies in suitable cases with multiple hydatid cysts. Cystotomy without capitomage and closure of the bronchial openings can be an alternative procedure in hydatid disease surgery. Albendozole treatment is necessary in the postoperative period to obtain good results without any recurrence.     

Giant hydatid lung cysts

Objective: In this clinical retrospective study, we aimed to evaluate giant hydatid lung cyst cases as a different clinical entity that recorded in last 10 years in our clinic. Methods: Between February 1990 and May 2000, a total of 305 hydatid lung cyst cases from patients that had been operated were reviewed, and 67 (21.9%) cysts with more than 10 cm in diameters of them were regarded as a giant hydatid lung cyst. Further investigations were made with respect to different factors. Results: Thirty-six (54%) cases were male and 31 (46%) were female. The ages ranged between 5 and 54 (mean 21.6) years. The most common symptoms recorded were; cough (68%), thoracic pain (55%) and dyspnea (52%). Cyst sizes were ranged between 10 and 22 cm (mean 13.4) in diameters. Forty-two (62%) of them were in the right, 22 (33%) were in the left hemithorax, and three (5%) were located bilaterally. Cystotomy or cystectomy and capitonnage was the most frequent applied operation procedure (71%). Resection was performed in nine (13%) cases. Thirteen (19%) cases had air leakage more than 10 days in which five (7%) of them empyema occurred postoperatively. One case died due to respiratory failure in fourth postoperative day. The postoperative hospital stay ranged between 6 and 43 (mean 10.5) days. No recurrence was recorded in 1–5 years of a follow-up period. Conclusions: Giant hydatid lung cysts must be regarded as a different clinical entity because of their early occurrence, having more serious symptoms, with frequent operative complications, and they need prolonged care with higher cost effects.     

Management of complicated hydatid cyst of the thorax

BACKGROUND: Complicated hydatid cyst of the thorax is important to the clinical approaches and treatment methods in hydatid disease. The aim of this study was to evaluate the problems of complicated pulmonary hydatid cyst, including choice of surgical methods, diagnostic clues and to discuss the inherent risks of medical therapy and the delay of surgical treatment in pulmonary hydatid disease. METHODS: Between 2002 and 2006, 40 operations were carried out in 37 patients whose diagnoses were complicated hydatid cyst. The surgical approach was a posterolateral thoracotomy in all patients; a phrenotomy in two patients and a thoracoabdominal approach in one patient and two-stage bilateral thoracotomy in four patients. The preferred surgical treatment procedure was cystotomy and modified capitonnage, which was carried out in 26 patients (70%). Other procedures included a cystotomy in five (14%) and decortication in six (16%) patients. Segmentectomy was carried out in 1 (3%), and wedge resection in four patients (11%). RESULTS: In 25 patients (67.5%), there were single hydatid cysts; whereas 12 patients (32.5%) had multiple cysts. Eleven patients had preoperative hydatid cyst history. Iatrogenic rupture of an intact hydatid cyst occurred in three patients. Extrathoracic involvement was apparent in 10 patients (27%). Intrathoracic but extrapulmonary involvement was apparent in six patients (16%). The morbidity ratio was 5%; there was prolonged air leak and atelectasis in one patient each. The mortality ratio was 3% (one patient). The average hospitalization duration for all patients was 5.7 days (range, 3-17 days). The mean follow up was 18.4 months with no recurrence. CONCLUSION: Complicated hydatid cyst may have different clinical manifestations and may present radiologically as a primary lung tumour. In patients with suspicious lung masses owing to endemic area, history of a hydatid cyst or contralateral or extrathoracic hydatid cyst involvement at the same time should indicate a complicated pulmonary hydatid cyst. Preoperative anthelmintic therapy must be avoided owing to the risk of perforation. Treatment of a complicated hydatid cyst differs from that of an intact hydatid cyst. Anatomic resection may be necessary owing to destroyed lung tissue secondary to suppuration from a hydatid cyst; however, parenchymal preserving surgery is preferable in an uncomplicated hydatid cyst. A modified capitonnage method is recommended for complicated hydatid cyst treatment as it has a low morbidity rate.     

Conservative Surgery for Treatment of Hydatid Cysts in Children

Human echinococcosis is endemic in Turkey and many other areas of the world. Fifteen years of surgical assessment related to involved structures, operative procedures, complications, and the recurrence rate is analyzed in pediatric patients with pulmonary and abdominal hydatid cysts. Between 1986 and 2001, the records of 42 pediatric patients (15 girls, 27 boys; ages 2–15 years) with pulmonary and abdominal hydatid cysts operated on in our clinic were analyzed retrospectively. The features of the disease, involved structures, operative procedures, complications, and recurrences were noted. A total of 26 patients presented with solitary cysts in the lung (9) and liver (17). Another 11 had multiple cysts in both lung and liver, and 5 had disseminated abdominal disease. Conservative surgical procedures were used for all lung and liver cysts: cystotomy (7) or cystotomy plus capitonnage (13) for lung cysts; partial pericystectomy with capitonnage (25), omentoplasty (28), tube drainage in the presence of bile leakage (5), or a combination of these procedures for liver cysts. Cyst excision was used for omental and peritoneal localizations when feasible. Radical procedures were never used (wedge or major liver and lung resections). Operative mortality was zero, and the morbidity rate was 14%. Three patients with disseminated disease (7%) showed recurrence. We suggest that no partial organ resections are necessary for hydatid disease, and highly successful results can be achieved using conservative surgical approaches, such as cystotomy plus capitonnage for lung cysts and partial pericystectomy with capitonnage, omentoplasty, or both for liver cysts.     

IS LOBECTOMY NECESSARY IN THE TREATMENT OF PULMONARY HYDATID CYSTS?

BACKGROUND: Hydatidosis is endemic in Turkey and many other areas of the world. The definitive treatment for pulmonary hydatidosis is surgical. The purpose of this study was the review of surgical therapy of our patients with pulmonary hydatid disease and the necessity of lobectomy. METHODS: We reviewed 107 patients: 26 of whom were women and 81 were men. The median age was 30 years (range, 7-57 years). Chest roentgenogram, abdominal ultrasound and computed tomography of the chest and upper abdomen were carried out as diagnostic study. All patients underwent thoracotomy and cystotomy with or without capitonnage. RESULTS: Four patients had two cysts in the same lobe and one patient had three cysts (one perforated and two intact) in the left lower lobe (4.6%). In nine patients, the cysts were >10 cm in diameter (8.4%). In 18 patients, the cysts were suppurative (16.8%). None of the patients required lobectomy. Of the 107 patients, prolonged air leaks (n = 8), atelectasis (n = 3) and empyema (n = 3; two had empyema preoperatively because of pleural perforation of cysts and the other had prolonged air leak) were observed in the postoperative period. There was no death. CONCLUSION: The effective treatment of hydatid cysts in the lung is the complete excision of the cyst with maximum preservation of lung parenchyma. We believe that the decision of lobectomy must be taken very carefully, even in the case of infected hydatid cysts, atelectasis, giant cysts and multiple cysts in the same lobe.     

Single-stage transthoracic approach for right lung and liver hydatid disease

OBJECTIVE: Human echinococcosis remains a serious health problem for the Mediterranean countries. Synchronous pulmonary and hepatic hydatid disease may occur in 4% to 25% of cases. Our experience on simultaneous surgical treatment of right lung and liver hydatid disease in patients was reviewed. METHODS: Between 1990 and 2000, 48 patients (33 female patients and 15 male patients) with synchronous right lung and liver dome hydatid cysts were operated with a 1-stage procedure. RESULTS: Six patients had previous surgical treatment of hepatic (n = 2) or pulmonary (n = 4) hydatid cyst. The pulmonary cysts were diagnosed with radiography in 18 patients and thoracic computed tomography scan in 30. The pulmonary cysts of 9 patients were bilateral. Seventy-five pulmonary cysts were seen in radiological examinations. The diagnosis of hepatic cysts was established with ultrasonography in 18 patients and upper abdominal computed tomography in 30. The total number of hepatic cysts was 48. In cases with pulmonary cysts, cystotomy and capitonnage were performed in 32 patients, only cystotomy was done in 14 patients, and wedge resection was performed in 2. Liver cysts were approached to transdiaphragmatically after the lung cysts had been dealt with and were managed with evacuation of the cysts. In the remaining cases, marsupialization (n = 2), pericystectomy (n = 1), and enucleation (n = 1) were performed. Major postoperative complications were hemorrhage (n = 1) and biliocutaneous fistula (n = 1). Hepatic recurrence was seen in 3 patients (6.2%) and pulmonary recurrence in 1 (2.1%). CONCLUSION: Transthoracic approach is a useful and a safe surgical management of both pulmonary and upper surface of hepatic hydatid cysts.     

Surgical treatment of pulmonary hydatid disease in children: report of 122 cases

BACKGROUND/PURPOSE: The aim of this study was to review the authors' surgical experience in pediatric pulmonary hydatid disease focusing on clinical presentation, parenchyma saving operations, and long-term results. METHODS: One hundred twenty-two children with pulmonary hydatid cyst were treated surgically over the last 2 decades and were reviewed retrospectively. There were 66 boys and 56 girls with a mean age of 9 years. RESULTS: Pulmonary hydatid cyst was seen in 111 (91%) patients and pulmonary and hepatic cysts in 11 (9%). Lateral thoracotomy was performed in 106 (87%) patients, thoracotomy and laparotomy in 6 (5%), median sternotomy in 5 (4%), lateral thoracotomy with phrenotomy in 4 (3%), and median sternotomy with phrenotomy in 1 (0.8%). Parenchyma-saving procedures were performed in 114 patients (93%) and lung resection in 8 (7%). There was no mortality. Postoperative complication was seen in 5 patients (4%). CONCLUSIONS: Parenchyma-saving procedures without capitonnage are preferable. In patients with right or bilateral lung and coexisting cysts in the upper part of the liver, thoracotomy or median sternotomy and transdiaphragmatic approach allows the surgeon to remove the lung and liver cysts in a single operation. Median sternotomy is an alternative method for the bilateral lung hydatidosis compared with sequential thoracotomy.     

Pulmonary hydatidosis: surgical treatment and follow-up of 240 cases

Objective: We review a series of 240 patients treated surgically for pulmonary hydatid cyst in our center between 1966 and 1988, assessing the results with our surgical technique, which involves a novel needle aspiration device designed by Professor D. Figuera, and postoperative treatment protocol. Patients and methods: The majority (60.4%) of the patients were from areas endemic for hydatid disease. The mean age of the patients at the time of the surgical procedure was 31.5±7.2 years (range: 4–70 years). A trocar-suction device was used for the needle aspiration of 276 (92%) of the 300 cysts encountered in the 240 patients. The remaining 24 cysts were removed integrally by means of different surgical techniques such as cyst enucleation, lobectomy, segmentectomy and atypical pulmonary resection. The residual cavity was treated by pericystectomy and eversion to the pleural surface in 238 cases (86.2%) and by capitonnage in 38 (13.7%). High vacuum suction (−30 cm H₂O) was employed in every case. Depending on when the procedure was performed, the patients were treated with mebendazole or albendazole according to the protocol designed by Bekhti. Results: Clinical assessment of the symptoms and plain chest X-ray led to the correct diagnosis in 228 cases (95%). In six (2.5%), imaging studies such as ultrasonography, computed tomography and nuclear magnetic resonance were required, and in the remaining six cases (2.5%), the diagnosis was established intraoperatively or in the subsequent histopathological study. One hundred and seventy patients (70.8%) presented a solitary lung cyst, while the remaining 70 (29.2%) were found to have multiple cysts in one or more lobes of one or both lungs. In addition, 45 patients (18.7%) presented hepatic cysts and 25 (10.4%) had cysts in other locations. After 18 years of follow-up, the survival rate was 94.6%. Of the surviving patients, 98.3% were free of pulmonary hydatid disease and 95.1% were free of hydatid disease. Conclusions: The trocar-suction device employed here for needle aspiration of hydatid cysts has demonstrated its efficacy in preventing the rupture of the cyst and its possible dissemination. With its use, the parasite is eradicated and the residual cavity can be excised.     

Surgical treatment of hydatid cysts of the lung: report on 1055 patients.

Of 1055 patients treated surgically for pulmonary hydatid disease, most (950) had isolated lung cysts, the other 105 having both liver and lung cysts. The chest radiograph was most valuable in diagnosis; the Casoni and Weinberg tests and blood eosinophil counts were found to be diagnostically unreliable. One thousand and seventy seven primary operations were performed. Cystotomy and capitonnage were carried out in 906 patients, 40 of whom also had decortication of the pleura. Other procedures included cystotomy with wedge resection of locally damaged lung (29 patients) and cyst removal with capitonnage by Ugon's method (33) or the Perez-Fontana procedure (8) and with costal resection for osteomyelitis in two cases. More radical surgery was carried out in 99 patients for longstanding infection or severe lung destruction. Postoperative complications occurred in 37 patients (3.5%) and the 30 day mortality rate was 1.7%. It is concluded that a lung conserving surgical operation is the treatment of choice for most patients with pulmonary hydatid disease. In patients with coexisting liver cysts the thoracic transpleural approach allowed the lung and liver cysts to be removed at the same session.     

Ruptured hydatid cysts of the lung in children: clinical review and results of surgery

BACKGROUND: Rupture of a hydatid cyst may cause some unique problems, especially in children. METHODS: Sixty-three children with a total of 68 ruptured lung hydatid cysts were operated on between 1980 and 2000. Mean age was 12.3 years (range, 1 to 15 years). Radiographic findings were hydropneumothorax (20.6%) and air-fluid level (19%). Mean follow-up was 19.3 months. RESULTS: Transthoracic needle aspiration was responsible for the rupture in 3 children. The interval between cyst rupture and operation was less than 24 hours in 10 patients (15.9%), 1 to 4 days in 36 (57.1%), and more than 4 days in 17 (27%). Resection rate was 22.1%. The most frequent operative method was cystotomy and capitonnage (38%). Morbidity was 25.4% (extended air leak 5, empyema 3, bronchopleural fistula 3, atelectasis 3, pneumonia 2). Mortality was 4.7% (hemoptysis 1, pneumonia and sepsis 1, aspiration of hydatid material 1). Morbidity and mortality seem to be more frequent in late cases. CONCLUSIONS: Early surgical intervention with single-lung ventilation and maximum parenchyma preservation are recommended.     

Surgical Treatment of Hydatidothorax Series of 79 Cases

Objective: A retrospective review of 79 cases of ruptured intrapleural pulmonary hydatid cysts. We analyse and evaluate our experience in the surgical treatment of this complication.

Materials and Methods: In a ten-year period, from 1990 to 1999, 79 patients were operated on in our service for intrapleural rupture of a pulmonary hydatid cyst. There were 51 males and 28 females with a mean age of 35.4 years. The diagnosis was established on the basis of different clinical signs and imaging studies.

Surgical approach consisted of a posterolateral thoracotomy in all cases. After decortication, different procedures were performed on the pulmonary lesions according to the importance of lung destruction.

Results: Radical resections were done in 48 cases, including lobectomies (15), segmentectomies (33) and conservative treatment: simple capitonnage and bronchial fistula closure (31).

Postoperative complications occurred in 8 cases (10.1%), including one pyothorax, one haemothorax, one prolonged air leak, two pneumonias and two wound infections.

There was one postoperative death, by respiratory failure. Ninety-five percent (95%) of patients were free of recurrence of thoracic hydatid disease in a follow-up ranging from 1 to 10 years (mean: 5.4 years).

Conclusion: Hydatid cysts of the lung should be treated before complications occur, particularly intrapleural rupture because it considerably increases morbidity.     

Comparison of pulmonary hydatid cysts in children and adults

BACKGROUND: The purpose of the present study was to compare the clinical features and the surgical approaches of the pulmonary hydatid cysts in children and adults. METHODS: One hundred and thirty-four patients, operated on for pulmonary hydatid cysts over the last 10 years were retrospectively evaluated in two groups: 39 children who were younger than 18 years old (29%) and 95 adults (71%). The patients in each group were analysed according to their clinical, radiological and surgical findings. RESULTS: The frequency of pulmonary hydatid cysts in children was significantly higher in boys (74%) than in girls (26%). However, there was no sex tendency in adults (52% in male vs 48% in women). The sex difference in hydatid cyst frequencies between adults and children was significant (P < 0.05). Among preoperative pleural complications, pneumothorax (15.5%) in children and empyema (11%) in adults were more frequent. The frequency of concomitant hepatic cysts was less in children than in adults (33%vs 79%). Huge pulmonary cysts (=10 cm) were more common in children (31%) than in adults (22%). Cystotomy with capitonnage was the most frequently preferred method in both groups. Postoperative complications developed in six children (16%) and 19 adults (19%), and were more frequent in patients with huge cysts (27%vs 16%). No recurrence was observed in both groups. CONCLUSIONS: Isolated pulmonary cysts are more common in children than adults. The cysts also tend to be bigger in children than adults. The frequency of concomitant hepatic cysts is less in children. Because of higher lung expansion ability and improvement capacity in children, resection should be avoided and lung saving surgical procedures should be performed. In spite of differences observed in the clinical features it does not change the treatment of pulmonary hydatid cysts in children.     

Surgical treatment of pulmonary hydatid cysts: is capitonnage necessary?

BACKGROUND: Hydatid disease of the lung caused by Echinococcus granulosus is frequently encountered in Mediterranean countries. The ideal surgical method for treating this disease is still unknown. METHODS: Between 1994 and 2001, 71 patients with pulmonary hydatid cysts were treated surgically. There were 41 male and 30 female patients with a mean age of 30.2 years (range, 5 to 70 years). Cystotomy and closure of bronchial openings were performed in all patients. Obliteration of the residual cavity by imbricating sutures from within (capitonnage) was achieved in 39 patients (group 1). There were 34 patients with intact cysts and 37 patients with at least one complicated cyst. The average diameter of the cysts was 6.4 cm, and the mean number of cysts per patient was 1.4. The surgical outcome was assessed in group 1 patients and in patients who had undergone closure of bronchial openings without capitonnage (group 2; n = 32). The groups were comparable in regard to clinical characteristics. RESULTS: There was no mortality. The total hospitalization time (mean +/- standard error of the mean) was 5.0 +/- 5.0 days for group 1 and 5.9 +/- 6.9 days for group 2 (p = 0.91). Stay in the intensive care unit was 1.64 +/- 1.22 days in group 1 and 1.60 +/- 1.52 days in group 2 (p = 0.90). The duration of air leak was 2.56 +/- 4.73 days in group 1 and 2.38 +/- 4.74 days in group 2 (p = 0.87). There was no significant difference between groups in the development of empyema (1 patient in group 2 only) and prolonged air leak (5 patients in group 1 and 4 in group 2). There was also no significant difference in the rate of recurrence (3 patients in group 1 only). CONCLUSIONS: We conclude that capitonnage provides no advantage in operations for pulmonary hydatid cysts.     

Management of pulmonary hydatid cysts in a tertiary care centre in Northeast India

Background

Hydatid cysts are the most common parasitic disease of the lungs. We reviewed our experience with pulmonary hydatid cysts focusing on clinical symptoms, diagnostic methodology, operative management and their outcome in our centre.

Methods

Between October 2008 and September 2013, 37 patients were operated in our department for lung parenchymal hydatid cysts. Twenty-six patients were female and 11 were male. The mean age of the patients was 30.6 years with a range of 16–44 years. The cysts were located in the right lung in 22 (59.46 %) patients, left lung in 14 (37.84 %) and bilaterally in 1 (2.70 %). We performed enucleation and capitonnage in 29 cases, cystotomy-drainage and capitonnage in 6 cases, wedge resection in 1 case and lobectomy in 1 case. Albendazole was given postoperatively to selected patients considered to be at high risk for recurrence.

Results

Chest X-ray, computerized tomographic scanning of the thorax was done in all cases for diagnosis. Most of the patients presented with solitary pulmonary cysts. One patient had bilateral pulmonary cysts and four patients had concomitant liver cysts. Postoperatively, there was no major morbidity. There was no in-hospital or 30-day mortality. The follow-up data was complete for 29 of the 37 patients. The mean follow-up period was 2.6 years with a range of 6 months to 5 years. During the said period, none of the patients had shown any recurrence.

Conclusion

Surgery for hydatid cysts of the lung can be safely performed, with low morbidity and a negligible mortality rate and is the treatment of choice.     

Cystotomy with Non-Capitonnage in Treating Children with Pulmonary Hydatid Disease

Purpose: Pulmonary parenchyma saving method (cystotomy and enucleation) has been globally accepted in lung hydatidosis. However, whether capitonnage is performed or not after cystotomy is still controversial. This study aims to improve the diagnosis and treatment of patients.Methods: We retrospectively analyzed the data of 12 pediatric patients with pulmonary hydatid cysts. These 12 patients (10 males and 2 females), with an average age of 8.7 years, underwent cystotomy without capitonnage. The mean follow-up period was 36 months.Results: Among the 12 patients, 10 underwent thoracotomy cystotomy and 2 underwent thoracoscopic surgery with excellent outcomes except one case of postoperative broncho-pleura fistula, which was treated through thoracoscopic surgery. The mean hospital stay was 8 days. No death or recurrence occurred during the follow-up period.Conclusion: Good therapeutic effect can be expected by combining cystotomy of pulmonary hydatid cysts with postoperative anti-hydatid drug therapy. For those unruptured (uncomplicated) hydatid lung cysts, cystotomy with the non-capitonnage method seems to be the best option, which needs to be verified by well-designed studies.     

Pulmonary Hydatid Disease: Report of 100 Patients

One hundred patients with pulmonary hydatid disease underwent thoracotomy and operative removal of the cysts. Of the 60 men and 40 women, most were between 3 and 19 years old. Cough, fever, dyspnea, and chest pain were the prominent symptoms in the majority of cases. Intact hydatid cysts were found in 67 patients and infected or ruptured cysts in 33. The Casoni skin test, Weinberg reaction, and eosinophilia were found to be unreliable diagnostic criteria and therefore were not used routinely in our patients. Roentgenological examination was the most valuable diagnostic aid. A single lobe was affected in 72 patients. Unilateral multiple foci were present in 15 patients and bilateral multiple foci in 13. Cystectomy and capitonnage were the preferred operative procedures in most cases. Pulmonary resection was necessary in only a limited number of patients.We conclude that conservative surgical methods such as cystectomy (with or without capitonnage) are preferable, especially for children, whose residual lung parenchyma has great capacity for expansion. The mortality rate among our 100 patients was 2%; both died of cardiac arrest during operation.     

Surgical Treatment for Lung Hydatid Disease

Lung is the second most common site for hydatid disease after the liver. The aim of this study is to present the clinical symptomatology, diagnostic evaluation, and surgical techniques for the treatment of lung hydatid disease. During the last 25 years, 42 patients with lung hydatid cysts were treated surgically in our department. In four patients there were cysts in the liver and in one case in the spleen. The cysts were located in the right lung in 16 patients (38%), in the left lung in 23 patients (54.8%), and in both lungs in 3 patients (7.14%). Eighteen patients (42.9%) presented with complications: suppuration in one patient (2.4%), rupture to the bronchial tree in 16 patients (38%), and pneumothorax in one patient (2.4%). Diagnosis was established preoperatively in all cases; chest radiography and computed tomography were most helpful for diagnosis. Forty-six operations were performed in 42 patients; three patients with bilateral cysts underwent staged thoracotomies, and one patient was reoperated for recurrent disease. All cases were managed surgically, with several types of radical (34 cases) or conservative (12 cases) procedures. Radical procedures were lobectomy and rarely pneumonectomy, which were used more often during the first half of the study period. Cystectomy with capitonnage, the most commonly performed conservative procedure, was mainly used during the second half of the study period. Postoperative morbidity was 15.2% and the 30-day mortality rate was 0%. In one case there was postoperative hemorrhage that required reexploration. The median hospital stay for uncomplicated cases was 12 days and for complicated cases 21 days. In conclusion, pulmonary hydatidosis often presents with complications requiring emergency surgery. A lung-conserving operation is the treatment of choice for lung hydatid disease and offers a good surgical outcome with a minimal recurrence rate.