Optimized Conservative Surgical Treatment of Pulmonary Hydatid Cyst: A Retrospective Observational Cohort Study.

Abstract

Background: There are some controversies on surgical options for pulmonary hydatid cysts. We analyzed our experience in lung tissue preservation during the surgical treatment and optimal surgical options.

Materials and methods: This observational cohort analysis was conducted from July 2008 to July 2022. The Age, sex, clinical manifestation, recurrent rate, hospital length of stay, postoperative complications, and long-term results in each group were assessed. The American Society of Anesthesiologists Physical Status, Charlson Co-Morbidity Index (CCI), Complexity of surgery, and Clavien-Dindo score were also determined.

Results: Out of 138 patients, 81case (53.5%) had intact cysts (G1), and the rest were infected cysts which in turn were subdivided into early infected (G2) and cavity suppurated=28 cases (18.4%) as (G3). Group G3 required special attention because the pericyst surface was severely inflamed, dirty, and had pus, so they were subdivided into 3 distinctive groups including G3a, undergone cystectomy, bronchial opening closure alone, G3b group, undergone cystectomy, capitonnage+bronchial opening closure and G3c group, in which pericystectomy also added to previously mentioned procedures. Major complications in the subgroups of G3a were 2 patients and G3b 3 patients, but in the subgroup of G3c, no considerable complications were seen. Cystectomy, closure of major bronchial opening, and capitonnage were done in intact, and early infected cysts. The results of both were the same, with no considerable major complication.

Conclusion: Capitonnage significantly decreased the complication rate. The optimized approach in both G1 and G2 was: cystectomy, closure of major bronchial opening, and capitonnage. In G3, bronchial opening closure, pericystectomy, and capitonnage were the preferred procedures.