One stage surgical management of hydatid cyst of lung & liver—by right thoracotomy & phrenotomy

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

Background: The association of pulmonary and hepatic hydatid cysts is rare. Managing this condition with low mortality and complications is a challenge. The aim of this study is to put forward our experience in managing both sites in single-stage posterolateral thoracotomy. Patients and Methods: A retrospective study of 14 patients who underwent single-stage posterolateral thoracotomy and phrenotomy to treat right lung and liver hydatid cysts between January 2010 and December 2019 were reviewed. Results: Fourteen of 135 patients (10.4%) with double location of hydatid disease were treated in our department for pulmonary hydatid cysts in the same period. There were nine males and five females who were 20 to 72 years old (average age, 42.7 years). Chest computed tomography (CT) and abdominal scan were performed in all cases. The surgical approach was posterolateral thoracotomy and phrenotomy without laparotomy in all cases. Conservation of hepatic and pulmonary parenchymas was possible in 13 patients (92.8%). Average operative time was 122 minutes (range, 95-210 minutes) and the average post-operative hospital stay was 8.7 days. Post-operative complications occurred in two (14.3%) cases, one was atelectasis and the other persistent biliary and air leakage. There was no post-operative mortality. All patients received post-operative medical treatment for three to six months and there was no recurrence after an average follow-up of 26 months. Conclusion: Single-stage thoracotomy is a better option than thoracotomy and laparotomy for the management of double located hydatid cysts. It has a lower complication rate, shorter hospital stay, and rapid resumption of normal activity.

Single-centre experience in treatment of multiple-site hydatid disease in a tertiary care centre of Eastern India

Background

Single-stage surgery for multiple-site hydatid cysts especially for the lung and liver is a less performed approach.

Objective

The aim of the study is to assess the feasibility of this approach in terms of outcome.

Methods

We studied 42 patients with multiple-site hydatid cysts over a period of 36 months admitted or referred to the department of CTVS of a tertiary-level hospital of Eastern India.

Results

Maximum numbers of cases were found in the age group of 11-20 years comprising 35.71% of the patient population with a female preponderance (18 versus 24). Chest pain was the commonest presenting feature (66.66%) followed by cough (52.38%), haemoptysis and dyspnoea 33.33% respectively. Eosinophilia was observed in four patients (9.52%). Twenty-two patients had simultaneous occurrence of pulmonary and hepatic hydatid disease (52.38%). Fourteen patients had only pulmonary involvement (33.33%). Chest wall (including the parietal pleura) was involved in six patients (14.28%). 23.03% patients presented with complicated cysts in the form of rupture into the pleura (19.35%) or the peritoneum (9.68%). Eighteen patients (42.86%) were operated via posterolateral thoracotomy and 18 (42.86%) were operated via thoracotomy with phrenotomy. Twenty-four patients (57.14%) underwent cyst excision by Barrett's technique. 59.09% patients underwent cystostomy for hepatic hydatids and five underwent omental packing (22.72%). Prolonged air leak was the commonest complication (35.71%). The mean operative time for thoracotomy was 136.87 min (~ 140 min) and 145 min for thoracotomy with phrenotomy. Only five patients (11.9%) required a prolonged intensive -treatment unit (ITU) stay of > 2 days and four had prolonged hospital stay > 15 days (1 of bronchopleural fistula, 1 of anaphylactic shock and 1 of bilateral lung cyst excision with postoperative lobar collapse).

Conclusion

Single-stage surgery is a viable option for multiple- and multi-site hydatids.

Video-assisted Thoracoscopic Surgery (VATS) with mini-thoracotomy for the management of pulmonary hydatid cysts

Background

Hydatid cyst is an endemic infectious disease. Various modalities have been provided to approach hydatosis. This article reports a 20-years-experience of a new minimally invasive technique for the management of solitary pulmonary hydatid cysts using video-assisted thoracoscopic surgery (VATS) with mini-thoracotomy.

Methods

We reviewed the medical records of patients who underwent unilateral or bilateral single pulmonary hydatid cyst excision using VATS with mini-thoracotomy. All patients were managed by the same surgeon over the period from January 1996 till January 2015.

Results

The study involved 120 patients aged between 11 and 74 years (median age = 30 years). The overall number of conducted surgeries was 130 (10 patients needed two surgeries). No deaths were reported during or after surgery. No recurrences were seen in the follow-up period that ranged between 10 and 30 months. Three patients (2.3% out of the 130 surgeries) developed post-operative complications: one patient had prolonged air leak and two patients developed empyema.

Conclusion

VATS with mini-thoracotomy is an effective and safe option for managing intact or ruptured solitary pulmonary hydatid cysts. Further studies in controlled prospective design are needed to compare this approach to other modalities of management.