Abstract
Thoracoscopic treatment of pulmonary hydatid cyst (PHC) has been considered to be a good treatment option in both children and adults for nearly 25 years. However, there have been very few pediatric studies published during this period. Our goal is to review our results and evaluate the efficiency of thorascopy in pediatric patients. The medical records of patients with PHC who were surgically treated between 2005 and 2015 were reviewed. As all cysts larger than 5 cm in diameter were surgically removed, cysts less than 5 cm in diameter were medically treated and were not included in the study. Demographics, cyst characteristics, and operative/postoperative data were compared between patients who underwent thorascopy (thoracoscopy group) and patients who underwent thoracotomy (thoracotomy group). Chi-square and t-test were used for statistical analysis where appropriate. There were 26 consecutive children (14 girls, 12 boys; mean age 9.4±2.7) included in the study. Except for 2 incidentally diagnosed patients, all were symptomatic, 4 had multifocal lesions, and multiorgan involvement was detected in 11 patients. Thoracoscopy was performed in 10 patients, and conversion was necessary in 2 patients due to unsuccessful fistula ligation attempts. The thoracoscopy group included 8 thoracoscopically treated patients, and remaining patients constituted the thoracotomy group (n=18). Comparison of preoperative characteristics of the groups was insignificant, whereas the overall complication rate (residual bronchial fistula, prolonged air leak, pneumothorax, and localized air cyst) and median hospital stay were significantly higher in the thoracoscopy group. There was no mortality and no recurrence at the postoperative follow-up after 37.4 months. The thoracoscopic approach to PHC may have a high risk of conversion and postoperative complication rate. Thoracotomy in children still seems to be the approach of choice for PHC larger than 5 cm. Routine thoracoscopic hydatid cyst treatment is yet far from being the gold standard, whereas thoracoscopy may be preferred in selected patients.
Highlights
Hydatid disease is endemic in many sheep- and cattle-raising areas, such as the Middle East, North Africa, South America, New Zealand, Australia, and India, and it still represents an important health hazard in these parts of the world
Thoracoscopy was performed in 10 patients, and conversion was necessary in 2 patients due to unsuccessful fistula ligation attempts
The thoracoscopic approach to pulmonary hydatid cyst (PHC) may have a high risk of conversion and postoperative complication rate
Summary
Hydatid disease (echinococcosis) is endemic in many sheep- and cattle-raising areas, such as the Middle East, North Africa, South America, New Zealand, Australia, and India, and it still represents an important health hazard in these parts of the world. Echinococcosis can involve any organ, with the liver being most commonly affected, followed by the lungs [1,2,3]. Small hydatid cysts of the lungs are treated with oral antihelminthic agents, whereas surgical intervention is necessary for large or recurrent cysts if medical therapy fails or drug side effects occur. The aim of surgical management includes eradication of the parasite, prevention of intraoperative rupture, ligation of bronchial fistula (if present), and obliteration of the residual cavity. These can be achieved by either standard postero-lateral thoracotomy or minimally invasive approach in adults, and in children, as stated in various recent reports [5, 6]
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