Pulmonary hydatid disease: is capitonnage mandatory following cystotomy?

Pulmonary hydatid disease still remains an important healthcare problem. Conservative operative interventions including cystotomy or cystotomy with capitonnage are the two commonly used techniques. There is still significant controversy, however, over selection of these two procedures. In this retrospective analysis of 66 patients with hydatid disease, we employed three types of interventions, Group A, (n = 5) cystotomy alone with closure of bronchial openings; Group B, (n = 54) cystotomy with capitonnage and Group C, (n = 7) lobectomy over a period of seven years in our patients and compared their postoperative outcome in terms of morbidity and mortality. Our data show that cystotomy with capitonnage is associated with low rates of postoperative prolonged air leak, bronchopleural fistula formation, empyema formation [mean complication rate 0.12% (Mean 0.08; 0.151-95% CI)] as compared to cystotomy alone with closure of bronchial openings [mean complication rate 44% (Mean 2.20; 3.18-95% CI)]. The lobectomy group was excluded from the comparison, as this approach is quite different from the cystostomy based enucleation techniques. We conclude that capitonnage with cystotomy may be a preferred procedure due to its lower rate of complications.