Thoracic approach of concomitant lung and liver hydatid cysts

Abstract

<b>Background:</b> Hydatid cyst (HC) is a parasitosis of main concern in traditional pastoral farming areas. Concomitant lung and liver HC, often raise problems in management. A thoracic approach, for both locations, had been reported in some series. <b>Aim:</b> The aim of this study was to determine the features of liver HC, eligible for a thoracic approach. <b>Methods:</b> We retrospectively reviewed the records of 85 patients managed, simultaneously, for concomitant pulmonary and liver HC, through a thoracic approach, between January 1996 and December 2019. <b>Results:</b> The mean age of our patients was 35 years old, with a sex ratio of 0.6. Six patients were previously operated for HC and 18.8% had comorbidities. Assessment of thoracic and abdominal locations was made with CT scan (50.6%) and ultra-sonography (83.5%). Lung HC were multiple in 21 patients and single in 64 (75.3%). Fourteen patients (16.5%) had bilateral lung involvement. The mean size of liver HC was 7 cm and the hepatic dome was the main location in 95.7%. A posterolateral thoracotomy associated with phrenotomy was used in all cases. For liver HC, resection of the protruding cyst dome was performed in 75 patients (88.24%). The postoperative course was uneventful in 67 cases (78.8%). The mean hospital stay was 9 days. Specific complications of liver HC surgery were noted in 5 patients (5.9%). Predictors of morbidity were hepatic cysts larger than 11 cm (p=0.033), cysts with bilious content (p=0.038) and the presence of a biliary fistula (p=0.016). <b>Conclusions:</b> In well-selected patients, liver dome hydatid lesions may be treated through a thoracic surgical approach, simultaneously with chest locations, without increasing morbidity.