Is lobectomy necessary in the treatment of pulmonary hydatid cysts?

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.

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.

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.

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.