Impact of the evolutionary stage of pulmonary hydatid cyst on the postoperative course

Abstract

Introduction: Hydatid lung disease is still endemic in several countries. Surgical treatment may be correlated with complicated course.

Methods: Retrospective review of patient operated for hydatid lung cyst with study of correlation between cyst’s evolution and post-operative course

Results: The total number of patients was 267, (116 men and 151 women). The median mean age was 26 years. All patients had a standard chest x-ray. Only 77.20% of patient had further exploration with a chest CT scan. Simple hydatid cyst represents 47,9% of cases, fissured hydatid 10,9%, partially vomited cyst 21,7%, and completely vomited cyst 19,5%. Posterolateral thoracotomy was the main approach in 97.40%. Treatment was conservative in 98.90% of cases. It consisted of cystectomy with partial peri-cystectomy. Padding of the residual cavity was performed in 79% of cases). An associated parenchymal resection was required in 3% of cases. Complicated post-operative course was found in 16.50% of cases with a mortality pf 1,49%. Prolonged air leak and pulmonary infection represented the main complications (11,3%). The analytical study showed that simple Hydatid cyst was associated with a significantly lower morbidity rate of 10.15% than the other groups (p = 0.008, OR = 0.39; 95% CI [0.19-0.79]). While completely vomited cyst are associated with a significantly higher morbidity rate of 28.84% than the other types (p = 0.007, OR = 2.6; 95% CI [1.27-5.32]).

Conclusion: Surgery remains the treatment of choice of hydatid cyst of the lung. Delay on the management of these cyst is correlated with greater morbidity. A screening strategy should be encouraged in endemic countries to treat hydatid cyst at an early stage