Parenchyma-Saving Surgical Treatment of Giant Pulmonary Hydatid Cysts

Abstract

Objective: The purpose of this study was to review 97 patients with giant pulmonary hydatid cysts and assess the clinical features and results of different operative techniques over a 27-year period. Material and Methods: Between January 1981 and December 2007, 590 patients were operated on for pulmonary hydatidosis and 97 (17 %) of these patients had giant pulmonary hydatid cyst. We retrospectively reviewed the medical records of these 97 patients. The diameter of the hydatid cysts were measured using radiological methods and intraoperatively. Results: Seventy-eight patients were male (80 %) and 19 were female (20 %). The median age was 23.4 years (range: 15–63 years). The most common symptoms were chest pain (54 %), cough (43 %) and dyspnea (41 %). Fourteen patients were asymptomatic (14 %). The diameters of the cyst ranged between 10 and 25 cm (mean 13.8 cm). The cysts were located in the right hemithorax in 52 (54 %) patients, in the left hemithorax in 44 (45 %) patients and bilaterally in one patient (1 %). Five patients had more than one cyst. The procedures consisted of cystotomy and capitonnage in 53 patients, enucleation and capitonnage in 27 patients and simple cystotomy or enucleation in 8 patients. Anatomical resection was performed in 9 patients. Prolonged air leakage of more than 7 days occurred in five patients; one patient underwent an operation and a Heimlich valve was placed in two patients. There was no postoperative mortality. Recurrence was not detected at follow-up after 6 months and 27 months. Conclusion: The higher lung tissue elasticity and delayed symptoms due to localizations of the cyst are the reasons for the occurrence of giant hydatid cysts in the lung. A parenchyma-saving operation should be performed instead of anatomical resection because of the low complication rates and because most complications can be treated conservatively.

Key words

hydatid disease - thoracic surgery - giant hydatid cysts

References

• 1 Aletras H, Symbas P N. Hydatid disease of the lung. Shields TW General thoracic surgery. Philadelphia; Lippincott Williams and Wilkins 2000: 1113-1122
• 2 Yuncu G, Sevinç S. Akciğer hidatik kistleri. Gogus Cerrahisi 1. Ankara; Basım Sim Matbaacılık 2003: 1011-1024
• 3 Karaoglanoglu N, Kurkcuoglu I C, Gorguner M, Eroglu A, Turkyilmaz A. Giant hydatid lung cysts.  Eur J Cardiothorac Surg. 2001;  19 914-917
• 4 Halezeroglu S, Celik M, Uysal A, Senol C, Keles M, Arman B. Giant hydatid cysts of the lung.  J Thorac Cardiovasc Surg. 1997;  113 712-717
• 5 Dakak M, Genc O, Gurkok S, Gozubuyuk A, Balkanli K. Surgical treatment for pulmonary hydatidosis (a review of 422 cases).  J R Coll Surg Edinb. 2002;  47 689-692
• 6 Gozubuyuk A, Savasoz B, Gurkok S, Yucel O, Caylak H, Kavakli K. et al . Unusually located thoracic hydatid cysts.  Ann Saudi Med. 2007;  27 311
• 7 Carmena D, Benito A, Eraso E. Antigens for the immunodiagnosis of Echinococcus granulosus infection: an update.  Acta Tropica. 2006;  98 74-86
• 8 Erdogan A, Ayten A, Demircan A. Methods of surgical therapy in pulmonary hydatid disease: is capitonnage advantageous?.  ANZ J Surg. 2005;  75 992-996
• 9 Bilgin M, Oguzkaya F, Akcalı Y. Is capitonnage unnecessary in the surgery of intact pulmonary hydatic cyst?.  ANZ J Surg. 2004;  74 40-42
• 10 Kavukcu S, Kilic D, Tokat A O, Kutlay H, Cangir A K, Enon S. et al . Parenchyma-preserving surgery in the management of pulmonary hydatid cysts.  J Invest Surg. 2006;  19 61-68