MANAGEMENT OF LUNG HYDATID DISEASE: REVIEW OF 100 CASES FROM THI-QAR / IRAQ

Abstract

  Objective: To present the advantages of elimination of the residual cavity after lung hydatid cyst removal by capitonnage associated with closure of the bronchial openings and partial pericystectomy via thoracotomy and to compare our study made at Al – Hussein Teaching Hospital in Thi-Qar governorate with those done in other centers and hospitals in Iraq and outside our country. Patients: This is a retrospective study of 100 patients for whom thoracotomy for lung hydatid cyst(s) was carried out over a period of about three years (from 1st of January 2013 till 1st of February 2016). Methods: The case sheets of relevant patients for whom thoracotomy for lung hydatid cyst(s) were carried out were reviewed to collect information like patient's sex, age, nature of surgery, method of obliteration of residual cavity after removal of hydatid cyst(s), etc… Results: All patients were admitted into Al-Hussein teaching hospital and thoracotomy was done for all of them regardless the age. Most of our patients suffered only from lung hydatid cyst(s) and several patients had also concomitant liver hydatid cyst(s) for which phrenotomy was carried out at the same session of thoracotomy to deal with the liver hydatid cyst(s). This concomitant phrenotomy to deal with the liver hydatid cyst(s) made the patient in no need for another surgery (laparotomy) in the future and the number of incisions and operations. A large number of our patients had no or mild symptoms   at time of examination. Higher number of patients had cough and several patients complained from hemoptysis. All patients were exposed to chest X-ray, chest CT – scan and abdominal U/S before surgery. During the operation, the hydatid cyst(s) was/were removed and the evacuation technique was most commonly applied and lobectomy was very rarely carried out. After removal of hydatid cyst(s), the residual cavity was mostly obliterated (capitonnage) to prevent collection of blood, exudate and possibly pus inside residual cavity and to seal the bronchial fistulae completely and ensure rapid expansion of lung. Conclusions: Pulmonary hydatid disease is endemic in Iraq and is diagnosed by imaging investigations and can be treated with minimal morbidity and mortality by lung preserving surgery. Elimination of the residual cavity after hydatid cyst removal by capitonnage was most commonly carried out. Hydatid disease affects children and young aged people and the management is always by surgery and there is no way for conservative treatment except for dead and calcified hydatid cysts.