One-staged anterolateral thoracotomy for bilateral lung hydatid cysts

Abstract

Background: Hydatid cyst disease is still a health problem in many countries. Surgical removal is the treatment of choice for lung hydatid cysts. However, operating on bilateral lung hydatid cysts is still controversial. The aim of this retrospective study was to evaluate the results of surgical treatment in bilateral hydatid disease of the lung. Methods: In this retrospective study, we reviewed our experience in the surgical treatment of 22 patients with bilateral, and at least three, lung and liver hydatid cysts. These 22 patients (14 male, 8 female) with an average age of 22 years (range 5–50 years) underwent one-staged bilateral anterolateral thoracotomy. Results: Out of 316 patients with hydatid lung, 22 (5.55%) were managed surgically. In total, 48 lung cysts were removed from 22 patients who underwent one-staged bilateral anterolateral thoracotomy. The most frequent symptoms were cough, chest pain, and dyspnea. Most of the cysts (38.2%) were located in the right lower lobe. Three patients had cysts associated with hepatic hydatid cyst; they were treated through phlebotomy during thoracotomies. All cysts were evacuated with capitonnage and without lung resection. We observed some complications such as prolonged air leaks (n = 3), atelectasis (n = 2), pneumonia (n = 2), and empyema (n = 1). No further surgery was required for the management of complications. The mean hospital stay was 5 days (range 8–12 days). No deaths occurred in hospital stay. Oral albendazole was started on the 2nd postoperative day thoracotomy in the dose of 10 mg/kg and was continued for 3 months with a gap of 2 weeks after each 28 days. No recurrences occurred during the follow-up period. Conclusions: One-stage surgery is superior to a classic two-stage approach as it decreases the morbidity, hospital stay, and costs. MS is an excellent approach, but in some cases, video-assisted thoracic surgery mini-thoracotomies could be indicated. In our experience, one-staged bilateral anterolateral thoracotomy is an appropriate surgical option for bilateral pulmonary hydatid cysts because morbidity rates are minimal, and the hospital stay is acceptable for the treatment of bilateral pulmonary hydatid cysts in one-staged option.