Capitonnage Results in Low Postoperative Morbidity in the Surgical Treatment of Pulmonary Echinococcosis

doi:10.1016/j.athoracsur.2011.11.011

The Annals of Thoracic Surgery

Volume 93, Issue 3, March 2012, Pages 962-966

https://doi.org/10.1016/j.athoracsur.2011.11.011 Get rights and content

Background

The main surgical techniques in the treatment of pulmonary echinococcosis are cystotomy alone, cystotomy and capitonnage, enucleation, and pericystectomy. Controversy persists regarding the selection of surgical technique. We reviewed our experience to identify the impact of capitonnage on outcomes.

Methods

A single-institution retrospective analysis was made of the 308 consecutive patients with thoracic hydatid disease treated surgically during 17 years.

Results

The most common presenting symptoms were cough and chest pain. At presentation, 69 patients (22.4%) had complicated hydatid disease, cyst rupture into bronchus in 62 and into pleural cavity in 7. Bilateral involvement occurred in 37 patients (12.0%), simultaneous hepatic cysts in 36 (11.6%), and intrathoracic extrapulmonary involvement in 14 (4.5%). Surgery consisted of cystotomy with capitonnage in 271 patients (92.2%), cystotomy and closure of bronchial openings in 20 (6.8%), and lobectomy in 3 (1.0%). Hospital mortality was zero; postoperative complications developed in 21 patients (6.8%).

Conclusions

Cystotomy with capitonnage has a low complication rate. Pulmonary resection is best limited to patients with parenchymal destruction secondary to infection.

Section snippets

Patients and Methods

The cases of 308 consecutive patients with pulmonary hydatid disease in a single institution between January 1993 and December 2009 were retrospectively reviewed. The study was carried out in agreement with Turkish laws on biomedical research and according to the principles outlined in the Helsinki agreement. All patients received full information and signed an informed consent form. The study group consisted of 163 male patients (53%) and 145 female patients (47%) whose mean age was 32.24 ±

Results

Assessment of clinical findings, chest roentgenograms, thoracic computed tomography, and thoracic ultrasonography led to the correct preoperative diagnosis of pulmonary hydatid disease in 270 patients (87.7%). The other 38 patients (12.3%) were diagnosed intraoperatively. In patients with intact lung cysts, 29% were asymptomatic with incidental diagnosis on routine chest radiograph. The remaining patients exhibited one or more symptoms, the most frequent symptoms being cough and chest pain (

Comment

The period of initial growth of primary hydatidosis is frequently asymptomatic. Symptoms may only occur when they grow to a certain size or when complications arise [7]. It has been reported that 8% to 32% of patients are asymptomatic at the time of diagnosis [8, 9]. In our study, the rate of asymptomatic patients was 22.4% in all patients, and 29% in those with intact lung cysts. Most common presenting symptoms were cough and chest pain. A rupture into the pleural cavity usually causes

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Citation Excerpt :
Infact pericystectomy in its entirety is not necessary and may cause complications such as severe air leak. On the other capitonnage can avoid the formation of a bronchopleural fistula or abscess in the remnant cavity [13]. When there is the need to treat an echinococcosis localized in the lungs, one of the major post-operative complications, especially in pediatric patients, is atelectasis.
Echinococcosis is a parasitic zoonosis in which humans are involved as an intermediate host. It is a very common pathology in the areas of Eastern Europe and Asia, where the main activity is represented by pastoralism and animal breeding. In humans, the most frequently affected sites are the liver (60–70%) and lungs (20–30%), manifesting themselves with symptoms such as abdominal pain, coughing, dyspnea, hemoptysis, up to cases of anaphylactic shock. In Italy it is not a common disease with an incidence of 2:100.000 inhabitants, and it's extremely rare in pediatric population. In this work we presented a case of a 11-years male patient came for a persistent cough, to whom was found a giant cystic mass in the thorax. Serological tests confirmed the diagnosis of echinococcosis. Patient underwent to thoracotomy to remove the cyst and he begun the antiparasitic therapy. Post-operative outcome was good and the patient is, until now, free of problems. Echinococcosis is a challenging problem for a pediatric surgeon, especially in non-endemic area, not only because it is not a common disease in pediatric population, but also for the surgical management that can presents some difficulties and complications in the post-operative course.
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Original articleGeneral thoracicCapitonnage Results in Low Postoperative Morbidity in the Surgical Treatment of Pulmonary Echinococcosis

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Comment

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Health statistics

Guidelines for treatment of cystic and alveolar echinococcosis

Bull WHO

Parenchyma-preserving surgery in the management of pulmonary hydatid cysts

J Invest Surg

Non-capitonnage method for surgical treatment of lung hydatid cysts

Asian Cardiovasc Thorac Ann

Methods of surgical therapy in pulmonary hydatid disease: is capitonnage advantageous?

Aust NZ J Surg

Hydatid cyst of the lung: diagnosis and treatment

World J Surg

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

Thorax

Original article
General thoracic
Capitonnage Results in Low Postoperative Morbidity in the Surgical Treatment of Pulmonary Echinococcosis