Thoracoscopic Cystostomy of Pulmonary Hydatid Cyst in Children

Year 2017, , 77 - 82, 21.04.2017

Gülnur Göllü

https://doi.org/10.1501/Tipfak_0000000968

Abstract

Aim: Echinococcosis is still an important health problem throughout the world, particularly in the
Mediterranean area. In humans, the lungs are the second most commonly affected sites. The disease may
affect children and its treatment may be challenging. In children, small hydatid cysts of the lungs respond
favorably to the medical treatment. Surgery is the standard option for the treatment of large and complicated
cysts. In current practice, thoracotomy and parenchyme-saving procedures such as cystostomy and
capitonnage remain the standard surgical approach for pulmonary hydatid cysts in children. However,
surgical experience with thoracoscopy is limited. The aim is to present the experience in thoracoscopic
management of pulmonary hydatid cysts in children.

Patients and Methods: Medical records of children who underwent thoracoscopic cystostomy of pulmonary
hydatid cysts between 2008- 2016 were reviewed. Surgical treatment was recommended for patients who
remained symptomatic on medical treatment and when the cyst size was larger than 6 cm in diameter.
Parenchyme-saving surgery was preferred which included cystostomy, removal of germinative membrane
and control of air leaks. Capitonnage was not preferred because of the risk of deterioration in lung capacity.

Results: Fifteen patients underwent 16 thoracoscopy procedures for pulmonary hydatid cysts. One of the patients
had bilateral complicated pulmonary hydatid cysts. There were conversions to mini-thoracotomy in 3 (20%)
procedures because the air leaks could not be controlled safely. The procedure was completed thoracoscopically in
12 patients. In thoracoscopically completed cases, prolonged air leak (over a week) occurred in 3 (25%) patients and
one of them underwent thoracotomy to control bronchopulmonary fistula. One of the patients underwent
laparoscopic cystostomy and capitonnage for associated liver hydatid cyst. There were no recurrences during 60
months of mean follow-up time and no problem was observed during the follow-up period.

Conclusion: Thoracoscopic management is recommended in children with uncomplicated hydatid cyst. In
complicated hydatid cysts, however, thoracoscopic wedge resection is recommended. If there is difficulty in
controlling bronchial openings, mini-thoracotomy could be considered. 

Keywords

Children, Hydatid Cyst

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