Long-term outcome of minimal access surgery for hydatidosis in children: a single institutional experience

Abstract

Human cystic echinococcosis continues to be a public health problem worldwide. The standard treatment of hydatidosis in children is open surgical intervention for removal of the cyst completely without spillage. The limited use of minimal invasive surgery (MIS) in hydatidosis has been due to the concern of inadequate removal and spillage, leading to recurrence or dissemination of the disease. Recently, a few authors have reported the successful use of minimal invasive surgery (MIS) for management of hydatid disease in children. We present our experience with successful use of MIS in the management of hydatid disease involving lung and liver in children. Between 2006 and 2017, data of 22 children treated for hydatid disease in our institute were reviewed. The diagnosis was made radiologically with Computerised Tomography scan of chest and abdomen. All children received albendazole therapy prior to and after the surgery. Thoracoscopic/laparoscopic procedures were undertaken sequentially in all children. Children with synchronous disease involving lung and liver had an interval of 2 weeks between procedures. The techniques of puncture, aspiration, injection and re-aspiration (PAIR) and also our modifications of cyst removal are described. There were a total of 22 children with liver and or lung involvement. Four children had synchronous lung and liver involvement and four children had bilateral lung involvement. The duration of the procedure ranged from 60 to 90 min. There were 3 (18) conversions in the thoracic group and 1 (12) in the laparoscopic group. PAIR technique with our modification of cyst extraction was used in all except in one child. Capitonnage of the cyst wall in lung hydatidosis was not done. There were no postoperative events. Recurrence of the lesion at original site was seen in two children, one each in laparoscopic and thoracoscopic group. Occurrence of new lesion or dissemination of the disease was not identified on a mean follow-up of 7 years. Our series demonstrates the safe and effective utility of MIS in management of pulmonary and liver hydatid in children. Use of MIS does not lead to dissemination of the disease. Albendazole therapy is an useful adjunct prior to surgery. Single lung ventilation with isolation of uninvolved lung is useful during surgery for lung hydatid.