Therapeutic evaluation of video-assisted thoracoscopic surgery versus open thoracotomy for pediatric pulmonary hydatid disease

Videothoracoscopic surgery in children

Video-assisted thoracic surgery (VATS) is now being used with increasing frequency for a wide variety of indications in pediatric patients. Although there is no high level of evidence for the advantages of VATS in the pediatric patient group, the proven benefits of this method in the adult patient group have encouraged thoracic surgeons to perform VATS in this patient population. In this study, the procedures performed in pediatric patients under 18 years of age and their results were reviewed with the help of articles obtained as a result of searches using relevant keywords in the English literature (PubMed, Web of Science, EMBASE, and Cochrane). The frequency, indications, and results of the procedures performed differed according to age groups.

Efficacy and safety of video-assisted thoracoscopic surgery and thoracotomy in the treatment of pulmonary hydatid disease in the Tibetan Plateau: a retrospective study

Background

Although video-assisted thoracoscopic surgery (VATS) plays an increasingly significant part in treating thoracic disease, the role of thoracotomy is not replaced in cystic echinococcosis. The aim of this study was to demonstrate the application of VATS and traditional thoracotomy in the treatment of pulmonary hydatid disease in Shigatse of the Tibet Plateau and to compare the clinical safety and efficacy of these two surgical approaches.

Methods

A total of 53 patients with pulmonary hydatid who received thoracoscopic cystectomy with needle aspiration from January 2015 to December 2020 were enrolled in the study, and 126 patients who received thoracotomy during the same period were matched as the control group. The clinical characteristics, operative time, incidence of perioperative complications, length of stay, and hospitalization cost of the VATS and thoracotomy groups were analyzed to compare the safety and efficacy. Patients were followed up through telephone and outpatient service. In order to balance potential confounding baseline factors, propensity-score matching (PSM) was applied to establish a 1:1 VATS to thoracotomy group ratio.

Results

There were statistically significant differences between the VATS group and the thoracotomy group in operative time, blood loss, drainage volume, and postoperative hospital stay (P<0.05), with the VATS group being superior to the thoracotomy group. There were no significant differences in postoperative complications, adverse imaging outcomes, or recurrence rates between the 2 groups. In terms of complications, there was no significant difference in the incidence of postoperative air leakage, atelectasis, or other common complications between the 2 groups, while the frequency of postoperative fever and incision infection in the thoracotomy group was significantly higher than that in the VATS group (P<0.05). Moreover, the postoperative recurrence rate between the 2 groups showed no significant difference after a 3-year follow-up.

Conclusions

Compared to traditional thoracotomy, VATS had acceptable efficacy and safety and it could further accelerate postoperative recovery and reduce the cost in the treatment of pulmonary hydatid disease in the Tibetan Plateau. Thus, VATS should be promoted more widely to other Tibetan regions.

Entzündliche und infektiöse Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen

Entzündliche Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen umfassen ein weites Spektrum von der komplizierten Pneumonie, der Tuberkulose, Mykosen bis hin zur Echinokokkose. Die Häufigkeit hängt stark von der geografischen Herkunft ab. Diese Übersichtsarbeit gibt einen Überblick von der Diagnostik bis hin zur chirurgischen Therapie dieser Erkrankungen beim pädiatrischen Kollektiv.

Uniportal Video-assisted Thoracoscopic Surgery (u-VATS) for Management of pulmonary hydatid cyst: A systematic review

Background and objectives

Hydatid disease of the lung, caused by Echinococcus granulosus, is an unusual parasitic disease. The aim of the current review for managing pulmonary hydatid cysts by uniportal video-assisted thoracoscopic surgery (u-VATS), and their complications, the size of hydatid cyst, length of hospital stay, surgery time, the rate of conversion from u-VATS to thoracotomy or mini-thoracotomy, follow-up, and outcomes.

Methods

We conduct the platform searches on the PubMed and Google Scholar electronic databases from inception to January 20, 2022, among patients diagnosed with pulmonary hydatid cyst (PHC) who underwent the u-VATS approach.

Results

This systematic review comprised five studies reporting 85 cases of PHC underwent (u-VATS) approach. Most patients were adults. The most common location of pulmonary hydatid cyst was the right lower lobe followed by the left lower lobe. The average size of PHC was 8.41 cm in all studies. The length of hospital stay was 3.85 days. The duration of operation time based on the means of the included studies was 86.19 min for each patient. Furthermore, the overall complication occurred in 9.35% of patients (n = 11) from 85 cases. The most complication was emphysema and prolonged air leak. The recurrence of pulmonary hydatid cyst did not occur in all studies.

Conclusion

The feasibility of the video-assisted thoracoscopic surgery (VATS) approach has been proven globally in terms of reducing the overall complication, shorter chest tube duration, shorter surgery time, reduce postoperative pain, shorter chest tube duration, lower chest tube drainage, and less required to pain killers postoperatively.

•

This systematic review comprised five studies reporting 85 cases of pulmonary hydatid cyst underwent (u-VATS) approach.

•

The median surgery time was 86.19 min and complications rate were 9.35%.

•

Uniportal video-assisted thoracoscopic surgery (u-VATS) is simple, safe and feasible for removal of pulmonary hydatid cysts.

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 Echinococcosis or Lung Hydatidosis: A Narrative Review

Background: Lung hydatidosis is a zoonosis related to infection by the Echinococcus tapeworm species. Lung involvement in this condition is second only to the liver echinococcosis. Diagnosis ordinarily results from an accidental finding in a direct chest radiograph evaluation because of the delayed growth of the cysts. Moreover, a consistent treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. In this review, we expect to sum up the main features of lung hydatidosis with a perspective on medical and surgical treatment. Methods: Cochrane Library and PubMed were the databases used to perform a narrative literature review. Search terms included "pulmonary echinococcosis" and "lung hydatidosis." The MeSH terms were "lung" [All Fields] AND {"echinococcosis" [MeSH Terms] OR ("hydatidosis" [All Fields] OR "pulmonary" [All Fields] AND "echinococcosis" [All Fields] OR "hydatidosis." A search period from September 1980 to May 2020 was chosen to compare studies from different decades, given the changes in pulmonary echinococcosis management. Results: A uniform treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. No clinical trials have analyzed and compared all the diverse treatment approaches. Cyst size, characteristics, position in the lung and clinical presentation, and the availability of medical/surgical expertise and equipment are the mainstays of echinococcosis management. When feasible, surgery is as yet the principal therapeutic choice to eliminate the cysts; anti-parasitic drugs may minimize complications during high-risk surgery or be used as definitive therapy in some instances with contraindications to surgery. Conclusions: Lung hydatidosis management must become less heterogeneous. We support treatment directed to the subject established on the clinical scenario, host factors, and surgical risk. Strict cooperation in this process between infectious disease specialists and surgeons may optimize best practices to help create shared practical guidelines to simplify clinicians' decision-making. Furthermore, we need a consensus for lung hydatidosis treatment and inserting this disease to global surgery agenda will have a positive impact on acquiring high-quality data that enables us to create an evidence-based guideline for this disease.

Thoracoscopic Transdiaphragmatic Excision of Hepatic Hydatid in Patients with Synchronous Pulmonary Hydatid: A Novel Operative Approach

Background: We wish to describe a novel technique of transdiaphragmatic excision of hepatic hydatid in patients with synchronous ipsilateral lung hydatid. Patients and Methods: Two patients, aged 11 and 6 years, presented with large synchronous hydatid cyst in right lung and liver. Second patient had two large cysts in right lobe of liver in posterior-superior segment of VII and VIII. The patients underwent thoracoscopic excision of lung cyst, and in same sitting the liver hydatid was seen bulging through the diaphragm. The diaphragm was incised to expose the cyst beneath, with excision of hydatid. Port-in-cyst technique was used to excise the membranes. Results: Both lung and liver cyst were successfully removed through thoracoscopic approach and a laparotomy was altogether avoided. Both patients did well in follow-up (3 years and 6 months). There are no respiratory issues in these patients. Conclusions: This is a novel approach for multiple synchronous hepatic and pulmonary hydatid. This can be applied in specific scenario as described. It gives a significant advantage of avoiding a laparotomy and thoracotomy in patients and thus reducing morbidity.

Uniportal-Single Incision Thoracoscopic Access for Pulmonary Hydatid Cysts

Objective:

Pulmonary hydatid cyst is caused by Echinococcus Species and has high prevalence in low and middle income countries. Surgery remains the gold standard method for this parasitic pulmonary disease. Here, we report 20 cases of pulmonary hydatid cysts that underwent minimally invasive videothoracoscopic surgery.

Methodology:

All the patients who underwent minimally invasive complete thoracoscopic removal of pulmonary hydatid cysts in our clinic, which were recorded in the hospital database had been extracted. Clinical properties and complications of the surgeries were analyzed retrospectively.

Results:

Minimally invasive method was performed in all 20 cases. The mean duration of operation was 95 minutes (min-max: 45-175), and the mean length of hospitalization was 3.55 days (min-max: 2-7). The complication rate was 15% (n=3) and there was no recurrence in 6 months of follow- up.

Conclusion:

Videothorascopic pulmonary hydatid cysts removal seems to be a safe and useful method. This method is applied in all suitable patients with pulmonary hydatid cysts.

Echinococcus Granulosus in Childhood: A Retrospective Study of 187 Cases and Newer Data

Echinococcus granulosus, first reported by Goeze in 1782, is the causative parasite of cystic echinococcosis (hydatidosis) especially for countries that are endemic areas. Since the 1970s, the incidence of echinococcosis in Greece has been very high. Nevertheless, with the implementation of special prevention measures in the 1980s, a large reduction in the incidence of hydatidosis meant that it reached European levels. Therefore, we analyzed the demographics, multiple organ localizations of the parasite, diagnosis, and conservative and optimal surgical treatment over a total period of 39 years, especially for pulmonary and hepatic echinococcosis in children. The higher incidence of pulmonary echinococcosis compared with other localizations, male predominance, wide range of age, and various cystic sizes were some of the main demographics. Because cystic echinococcosis remains a main public health problem, we advocate a meticulous clinical investigation and treatment methodology to bridge the gap between knowledge and awareness of this important disease.

Uniportal Thoracoscopic Approach For Pulmonary Hydatid Cyst: Preliminary Results

PURPOSE

Pulmonary hydatid cyst is a preventable parasitary disease with high prevalence in low-medium income countries. Thoracoscopic approach is seen in the literature as small-case groups and multiple-port incisions are observed in these studies. Unlike other thoracoscopic approaches for the surgical treatment, we describe the single-port technique for the first time in our study. We attempt to compare the clinical outcomes and preliminary results of patients with pulmonary hydatid cyst treated with either minimally invasive or thoracotomy.

METHODS

The medical records of 66 patients undergoing surgery for pulmonary hydatid cyst disease between January 2013 and July 2017 were reviewed. The number of patients who underwent thoracotomy was 48, whereas 18 were managed by single-port video-assisted thoracoscopic surgery. Variables statistically compared between the 2 groups were age, diameter of the cystic, operation time, volume and duration of the drainage, postoperative complications, length of stay, duration of narcotic analgesic usage, and pain score.

RESULTS

Thoracoscopic approach was superior to conventional thoracotomy in terms of operation time, drainage volume, time to drain removal, hospital stay, narcotic analgesic treatment duration, and postoperative pain scores. All thoracoscopic procedures were concluded successfully, and conversion to open surgery was not required. No postoperative mortality was seen in either group. During the follow-up period, no recurrence was encountered in either group.

CONCLUSIONS

Uniportal thoracoscopic approach is a safe option for the treatment of hydatid cyst disease. It can be used as an alternative to thoracotomy, depending on the size and location of the lesion.

Trust the Capitonnage in the Giant Cyst: Case Report

Cyst hydatid in the lung is still a health problem for many countries. It develops in the lung and can grow into the lung parenchyma. When it is diagnosed as a giant cyst, surgery should be performed. In the surgery, capitonnage is necessary to protect the lung parenchyma.

Is Bilateral Staged Muscle-Sparing Thoracotomy Performed within 1 Week for Lung Hydatid Cysts Safe for Pediatric Patients?

OBJECTIVES

Median sternotomy or staged thoracotomies are generally the preferred surgical treatment options for bilateral lung hydatid cysts. According to literature, it is usually recommended to wait from 3 weeks to 3 months between bilateral staged thoracotomies. The aim of this study is to compare postoperative complications, hospitalization days and morbidity and mortality ratios between unilateral thoracotomy and bilateral staged thoracotomy groups and to evaluate the safety of performing bilateral staged thoracotomy within 1 week for lung hydatid cysts in pediatric patients.

MATERIAL AND METHODS

In total, 112 patients under the age of 16 years who underwent surgery between 2000 and 2016 because of pulmonary hydatid cysts were included in this study. The patients were classified into two groups as Group 1 (unilateral muscle-sparing thoracotomy) and Group 2 (bilateral staged muscle-sparing thoracotomy applied within 1 week).

RESULTS

There were 91 patients in Group 1 and 21 patients in Group 2. No statistically significant differences were detected when both groups were compared by age, gender, perforation rates, follow-up period and postoperative complications.

CONCLUSION

To prevent hydatid cysts complications, the elapsed time between two thoracotomies should be not only long enough to evaluate the postoperative complications but also relatively short to prevent possible complications that may develop in the other lung. In our opinion, a patient follow-up of 3-7 days between thoracotomies is sufficient for the assessment of patients' clinical status and possible complications.

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

Objectives:

To compare results of surgical treatment and complications of patients with unilateral or bilateral thoracic and combined pulmonary echinococcosis.

Methods:

This cross-sectional analysis of a prospective study was conducted in the Department of Thoracic and Pediatric Surgery, Scientific Center of Surgery, Almaty, Kazakhstan among 598 patients with pulmonary echinococcosis, who had surgical treatment with various surgical methods, depending on the prevalence of echinococcosis, as follows: right lung in 357 (59.5%) patients, left lung in 243 (40.5%) patients, bilateral in 95 (15.8%) patients, and complicated echinococcosis in 317 (52.8%) patients. Length of stay per hospital stay has been decreased (p<0.0001) by video-thoracoscopic echinococcectomy with the high-energy laser (HEL) treatment of cyst, than after echinococcectomy by cyst treatment with povidone-iodine. Treatment with formalin presented the most longest hospital stay (p<0.0001)

Results:

Comparative analysis of patients with uncomplicated and complicated pulmonary echinococcosis showed a high frequency of postoperative complications associated with complicated echinococcosis (OR = 2.2, p<0.0001).

Conclusion:

Despite the success of surgical treatment of pulmonary echinococcosis, issues of intraoperative dissemination and safety remain, and treatment success rates can be improved. These factors require further prospective multicenter studies.

Muscle sparing lateral thoracotomy: the standard incision for thoracic procedures

Lateral thoracotomy is a versatile approach with many variations and is currently the most widely used incision in thoracic surgery. In the current article we are presenting the muscle-sparing lateral thoracotomy in the lateral decubitus position which we consider to be the “standard” for lateral thoracotomies. Indications, surgical technique and pitfalls are described alongside our experience with thoracic drainage. Although there is no consensus regarding the name of this incision, some authors call it “axillary thoracotomy” while others call it a “modified lateral thoracotomy”, they all agree on one aspect – the importance of muscle sparing – which makes it the go-to thoracotomy for both small and large procedures involving the lung. Lateral muscle sparing thoracotomy allows for good exposure of the pulmonary hilum, fissures, apex and diaphragm. The approach is easy and quick to perform while at the same time ensuring faster postoperative recovery by sparing the latissimus dorsi muscle, better cosmetics and lower postoperative pain score when compared to the posterolateral or classical lateral thoracotomies.