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Pulmonary hydatidosis in children
1Department of Pediatric Surgery, Ege University, Faculty of Medicine, Izmir, Turkey.
Insights
Surgical management of pulmonary hydatid disease can preserve lung tissue by leaving the cavity open after cyst removal. This approach, with continuous drainage, promotes lung inflation and avoids extensive suturing, reducing fibrosis.
Area of Science:
- Thoracic Surgery
- Parasitic Diseases
- Pulmonology
Background:
- Pulmonary hydatid disease requires surgical intervention.
- Preserving lung parenchyma is crucial for patient outcomes.
Purpose of the Study:
- To evaluate a surgical technique for pulmonary hydatid disease that preserves lung parenchyma.
- To assess the efficacy and complications of this conservative surgical approach.
Main Methods:
- Retrospective analysis of 88 patients operated on for pulmonary hydatid disease (1963-1991).
- Focus on a technique leaving the cavity open with sutured air leaks and continuous drainage.
- Comparison with other surgical methods like enucleation and resection.
Main Results:
- 67 patients underwent parenchyma-preserving surgery.
- Continuous drainage led to complete lung inflation in all cases.
- Complications included bronchopleural fistula (11 patients) and empyema (4 patients).
- 86 patients were symptom-free long-term.
Conclusions:
- Extensive suturing to obliterate residual cavities is unnecessary and leads to fibrosis.
- A parenchyma-preserving technique with open drainage is effective for pulmonary hydatid disease.
- Minimizing lung resection improves long-term outcomes.
Abstract:
In the years 1963-1991 inclusive, 88 patients were operated on with a diagnosis of pulmonary hydatid disease. The cysts were intact in 69 and infected in 19 cases. It was possible to use a surgical technique that preserved the pulmonary parenchyma in 67 patients. In this technique, the cavity after removal of the mother membrane is left open and only the air leaks are sutured. Continuous postoperative drainage of the residual cavity and the ipsilateral hemithorax always resulted in complete inflation of the affected lung. Enucleation of the endocyst and extended resection of the sclerotic pulmonary parenchyma were performed in 15, enucleation and obliteration in three, lobectomy in two and Barrett's method was applicable in one patient. A bronchopleural fistula developed in 11 patients postoperatively and in four of these cases a second thoracotomy was necessary. Postoperative empyema developed in four cases. There were two postoperative deaths in the series. Eighty-six patients were symptom-free in the long-term postoperative follow-up. We conclude that in the surgical management of the disease it should not be necessary to obliterate the residual cavity with extensive suturing which always leads to extra fibrosis with loss of viable pulmonary parenchyma.