Effect of size on the surgical management of pulmonary hydatid cyst

Hydatid cyst disease is a parasitic disease caused Echinococcus granulosus. Hydatid cysts of 10 cm or greater in diameter are called "giant" cysts and traditionally have been considered to be more difficult to treat surgically often requiring pulmonary resection. In this study we reviewed our experience with pulmonary hydatid cysts.

This study was carried out in Thoracic surgery unit Lady Reading Hospital Peshawar, from 1st June 2007 to 31st May 2012. Patients admitted with intra-thoracic hydatid cysts were evaluated. Patients were divided into 2 groups, i.e., patients who had cysts < 10 cm (group A) and those who had large cysts which were 10 cm (group-B). Data regarding age, sex, symptoms, diagnostic procedures, anatomic location of cysts, surgical procedures, complications, and outcomes were collected and analysed.

Total of 224 patients underwent hydatid cystectomy. Group A comprised 190 patients (85%), Group-B comprised 34 patients (15%). Large cysts were more common in younger patients. The most frequent complaints were cough, chest pain, and dyspnea. Patients with large cysts were more often symptomatic at presentation. In both groups, lower-lobe locations predominated. Parenchyma-saving operations were almost uniformly performed for each group; however, a higher percentage of patients in group B required anatomic resection (5.8% vs. 1%). Cystic rupture occurred more frequently in group-B than in group-A (26% vs. 12%). There were no deaths in either group, and the morbidity was 23 (12%) in (group-A) and 6 (17.6%) in (group- B).

Large hydatid cysts of the lung occurred more often in younger patients and were more often symptomatic at presentation. Regardless of size, the cysts could usually be surgically treated without lung resection, and size did not appear to influence short-term post-perative outcomes.