systematic review and meta-analysis on the treatment of liver hydatid cyst: comparing laparoscopic and open surgeries

Background and Study Aims: There is an academic debate regarding surgical interventions for liver hydatid cystdisease. The purpose of the current systematic review and meta-analysis study was to analyse the pros and cons of open surgery and laparoscopic techniques, considering the outcomes of liver hydatid cysts

Methods: Descriptive Boolean queries were used to search PubMed and Scopus for articles published between January 2000 and December 2016 to evaluate the outcomes of liver hydatid cyst in terms of mortality, post-operative complications, cure rate and recurrences. The data related to the four outcomes of liver hydatid cyst were extracted, assessed and then used as their corresponding effect sizes in the meta-analysis process

Results: Six studies totally consisting of 1028 patients [open surgery group = 816 [+7 converted to lap] and laparoscopic group = 212] were analysed. In this meta-analysis study, random effects models of outcomes [i.e. post-operative complications, mortalities, recurrences and cure rate] of the two procedures were OR = 0.852, LL = 0.469, UL = 1.546, Z = -0.526, p = 0.599 [for post-operative complications]; OR = 0.849, LL = 0.141, UL = 5.105, Z = -0.179, p = 0.858 [for mortality]; OR = 0.903, LL = 0.166, UL = 4.906, Z = -0.119, p = 0.906 [for recurrence]; and OR = 0.459, LL = 0.129, UL = 1.637, Z = -1.201, p = 0.230 [for cure rate]. Meta-analysis and illustrated forest plots showed that there are no superiorities between the two approaches. The results of heterogeneity tests of the above mentioned outcomes were Q = 8.083, df = 5, p = 0.152, I[2] = 38.142% for post-operative complications; Q = 0.127, df = 2, p = 0.938, I[2] = 0% for mortality; Q = 4.984, df = 2, p = 0.083, I[2] = 59.874% for recurrence; and Q = 10.639, df = 5, p = 0.059, I[2] = 53.001% for cure rate. The results of regression tests based on Egger's, smoothed variance based on Egger [SVE] and smoothed variance based on Thomson [SVT] showed that the p values are not significant, and there are neither significant statistical differences nor publication bias between the outcomes of the two treatment procedures

Conclusion: The results show no promising trends towards advantages of open versus laparoscopic surgeries in the treatment of liver hydatid cyst. However, informative measurement values for comparing these surgeries could be derived for complications, recurrence, mortality and cure rates. Furthermore, all three tests, namely Egger's, SVE and SVT regression models, were used to assess publication bias and showed no evidence for the existence of publication bias

Surgical management of calcified liver hydatid cyst complicated with thoracobiliary fistula: a case series and literature review

Thoracobiliary fistula is a rare complication of hydatid cyst of the liver especially in the calcified form. Surgery is the only medical option. The treatment consists of radical surgical procedures in the majority of the patients. Conservative surgical treatments are performed with high mortality rate. Herein, we will describe two patients of calcified hydatid cysts of the liver whose condition becomes complicated with Thoracobiliary fistula. The first patient was treated with right thoracotomy and resection of pleural hydatid cysts. Then, were evacuated the ruptured laminated membrane and daughter cysts of infected hepatic hydatid cysts through diaphragmatic opening and sub diaphragmatic drainage of the calcified liver hydatid cyst. The second patient was also treated with right thoracotomy, resection of pulmonary hydatid cysts, evacuation of ruptured bile stained laminated membrane and daughter cysts of hepatic hydatid cysts through diaphragmatic opening and sub diaphragmatic drainage of the calcified cyst cavity. Our patients underwent conservative surgery which posed a severe risk. Both cases are discussed together with review of the literature

role of pyloromyotomy on gastric drainage in esophagectomy and gastric pull-up procedures: a randomized clinical trial study

Introduction: Gastric drainage disorder is one of the complications of gastric pull-up and esophagectomy after surgery which might lead to esophageal cancer and benign strictures. The aim of this study was to determine the role of pyloromyotomy on gastric drainage

Materials and Methods: In this prospective randomized controlled clinical trial study, we studied 51 patients in two matched groups from July 2008 to August 2010 in Imam Reza Hospital, Tabriz,Iran. Twenty-seven patients in group one had no pyloromyotomy and 24 patients in group two had pyloromyotomy after transhiatal esophagectomy and gastric pull-up procedure. The outcomes were measured as the incidence of gastric outlet compromise which was diagnosed 12 months after esophagectomy and gastric pull-up. Regurgitation, fullness, respiratory distress, coughing and, clinical delayed gastric emptying were observed and compared in two groups by radioisotope gastric emptying scanning

Results: A total number of 51 patients, 19 [37.25%] male and 32 [62.75%] female were studied in this research. The overall incidence of delayed gastric emptying was 19 /51 [37.25%]. Pyloromyotomy did not reduce the incidence of delayed gastric emptying. There was no statistically significant difference in the length of hospital stay in study groups [group 1= 11 days versus 12 days in group 2, P=0.41]. There was no statistical difference in anastomotic leak or anastomotic stricture [P= 0.72]. Mortality was two [one patient, 3.7%, in group 1 and one patient, 4.2%, in group 2]. The incidences of regurgitation and increased gastric emptying were not statistically different in two groups

Conclusion: Pyloromyotomy could not reduce the incidence of delayed gastric emptying after transhiatal esophagectomy, and vagotomy

Squamous cell carcinoma on the remaining sequel of tuberculosis, presented as pancoast tumor 8 years later

Herein a 46 year-old man is presented with intolerable severe pain of right shoulder radiating to right arm and fourth and fifth fingers. He had a history of right upper lobectomy due to complicated tuberculosis eight years ago. Based on the findings of clinical examination and computed tomography imaging, diagnosis of Pancoast tumor of the right chest apex was confirmed. However, Fine Needle Aspiration [FNA] under computed tomography [CT] guidance was not conclusive. By performing a limited thoracotomy, multiple biopsy specimens were obtained from the mass and destroyed ribs for histopathologic examination which consequently confirmed the diagnosis of squamous cell carcinoma. Eventually, the patient was referred to the radiotherapy ward for treatment of Pancoast tumor

Delayed concurrent chylothorax and chyloperitoneum: report of a case after an old blunt trauma

A 15-year-old boy was referred to Imam Reza Hospital with a right chest tube and chylothorax for 40 days. The patient had respiratory distress and undergone refractory treatment for chylothorax. The fluid content was chyle-rich in lipids. Computed Tomography of the chest showed a large, incompletely evacuated cyst in the left posterior mediastinum with left pleural effusion. The cyst could not be resected through right thoracotomy, because of the left side location of the cyst. Ligation of the thoracic duct through right thoracotomy was not effective in reducing chylous effusion 4 days later. Left chylothorax exacerbated because of the complication of right thoracotomy. Laparatomy was performed to ligate the thoracic duct 6 days later. On exploratory laparatomy, chylous effusion was detected in the peritoneum.Thoracic duct with all the fibro-fatty tissues was ligated below the diaphragm over the spine at 12th to 2nd vertebral spaces. Right chylothorax was resolved after ligation of thoracic duct transabdominally 1-2 days later. Left chylous effusion was decreased and treated 46 days after laparatomy. One year follow up of the patient showed excellent result. In our knowledge, thoracic duct cyst occurring as a result of a delayed chylothorax and chyloperitoneum has not been reported in the literature. Surgical thoracic duct ligation can be the treatment of choice

comparative study of postoperative pulmonary complications using fast track regimen and conservative analgesic treatment: a randomized clinical trial

Postoperative pulmonary complications and pain are important causes of postoperative morbidity following thoracotomy. This study aimed to compare the effects of fast track and conservative treatment regimens on patients undergoing thoracotomy. In this randomized controlled clinical trial, we recruited 60 patients admitted to the thoracic ICU of Imam Reza Hospital in two matched groups of 30 patients each. Group 1 patients received fast track regimen randomly;whereas, group 2 cases randomly received conservative analgesic regimen after thoracotomy and pulmonary resection. The outcome was determined based on the incidence of pulmonary complications and reduction of post-thoracotomy pain in all patients with forced expiratory volume in one second [FEV1] <75% predicted value which was measured while the patients were in ICU. The length of ICU stay, thoracotomy pain, morbidity, pulmonary complications and mortality were compared in two groups. A total of 60 patients, 45 [75%] males and 15[25%] females with ASA class I-III were recruited in this study. Postoperative pulmonary complications were observed in 5 [16.7%] patients in group 1 versus 17 [56.7%] patients in group 2. There were statistically significant differences in development of postoperative pulmonary complications such as atelectasis and prolonged air leak between both groups [P< 0.001 and P=0.003]. There was also a statistically significant difference in the rate of preoperative FEV1 [p=0.001] and ASA scoring [p=0.01] and value of FEV1<75% predicted in the two groups. The difference in length of ICU stay in two groups was statistically significant [P= 0.003 and P=0.017 in FEV1<75% group]. Four patients in group 1 and 9 patients in group 2 had FEV1reduced to less than 75% of predicted value [p=0.03]. Using fast track regimen reduced postoperative pain and incidence of some pulmonary complications significantly when compared to the conservative regimen following thoracotomy and various lung surgeries

comprehensive study of mediastinal goiters

Thyroid masses are common, especially in areas of iodine deficiency. Mediastinal goiter is defined by the presence of enlarged thyroid tissue below the level of the thoracic inlet. This study aimed to evaluate the presentation, diagnosis, treatment, histopathological findings and complications of patients with mediastinal goiter or masses. This was a descriptive cross-sectional chart review study of patients with substernal goiter or masses who underwent cervical and mediastinal thyroidectomy from March 2003 to February 2007. From a total of 470 patients admitted for thyroid surgery, 60 cases [12.7%] presented with substernal extension of goiter or masses during the study period; 88% of patients were females with a mean age of 46.77 +/- 10.77 yrs. Cervical masses were the most common preoperative presentation [78%], followed by compressive symptoms [67.8%]; 5.08% of cases were asymptomatic. In 10%, the goiter or masses were located in the posterior mediastinum. Total thyroidectomy was performed in 59% of patients mostly by low collar incision. Sternotomy or thoracotomy was required in three patients [5%] mainly because of mediastinal masses or invasion of carcinoma. Postoperative complications included transient hypocalcaemia [46%] and persistent recurrent nerve paralysis [3.4%]. There was no mortality. Histopathologically, 18.5% of masses were malignant; mostly papillary carcinoma. Presence of substernal goiter or masses is an indication for early surgery, even in asymptomatic or elderly patients. These masses have progressive enlargements and carry a high risk of tracheal compression

Acute nonpenetrating tracheobronchial injuries: what is important in the mortality?

Nonpenetrating tracheobronchial disruption are rare and potentially life threatening and associated with blunt thoracic trauma. Sometimes diagnosis is missed. 2340 traumatic patents were admitted to the trauma center of Tabriz University Hospital, Iran. Only twelve patients of them had ruptured tracheobronchial airways following blunt chest trauma. In this retrospective study of twelve patients, we aim to document and evaluate causes, presentation, and diagnosis and treatment modalities over fourteen years [1993- 2006]. All the cases admitted to our referral hospital from six hours to 72 hours, underwent surgical interventions. There were two deaths; one in the operating room because of massive bleeding of pulmonary vascular disruptions coexisted with tracheobronchial injuries and in other due to severity of disruption of carina, right and left bronchus five days after repair. Diagnosis was missed in one patient and he repaired after six month. Stricture formation of anastomotic site and localized empyema with bronchopleural fistula were the complications of two patients. A high-level of suspicion in blunt thoracic trauma and use of bronchoscopy confirm the diagnosis of tracheobronchial disruption. Early diagnosis of tracheobronchial disruption is important, but severity of disruptions predisposes mortality

Retained surgical [lap- pack] mimicking bronchiectasis: a case report

Retained surgical [lap-pack] in thoracic cavity is a rare complication of thoracic surgery, and its incidence is unknown. Because of rarity of this condition and its nonspecific clinical and radiographic presentations, the diagnosis is frequently missed. Herein we report a man who has presented by symptoms and signs of pneumonia with leg upper zone consolidation on chest x-ray and broncluectatic appearances on CT scan He had a history of left upper lobectomy four years ago for bronchiectasis. The patient has been referred for resection of recurrent bronchiectasis. After thoracotomy, crumpled and destroyed retained abdominal lap-pack and evidence of anaerobic infection was found in pleural space. Foreign body and purulent material was removed and discovered bronchopfeural fistuia was closed. For chronic empyema and evidence of recurrent bronchopleural fistula, thoracoplasty was performed

Massive life-threatening hemoptysis from pulmonary hydatid cysts: a 13 - year experience from an endemic area

Echinococcosis is a parasitic disease often seen in sheep and cattle raised in countries with unsanitary conditions. The disease is encountered endemically in northwest of Iran. Life-threatening hemoptysis due to a pulmonary hydatid cyst is a rare condition. This study assessed the prevalence and treatment of this condition. Materials and In a retrospective study, between 1993 and 2005, 520 patients with pulmonary hydatid cysts were operated at the Imam Khomeini Hospital in Tabriz, Iran. Ten [1.9%] cysts exhibited life-threatening hemoptysis [Group II]. The remaining 510 patients with pulmonary hydatid cyst were studied [Group I] and compared with group II. Ten patients were included in group II, with a mean follow - up of 2.5 years. Four [40%] cases were males and six [60%] were females. The age ranged between 8 and 46 [mean 27.90 +/- 13.86] years. The most common symptoms were cough [100%], massive hemoptysis [100%], respiratory distress [100%], and chest pain [90%]. The amount of hemoptysis was between 600 and 1400 ml [mean 840 +/- 249.66] a day. The origin of bleeding in six [60%] was from the cyst in the right lung and in four [40%] from the left lung. Bronchoscopy revealed the site of bleeding in all 10 patients, and the lobe in seven [70%]. Chest x-ray and CT scan showed patchy infiltration in one or both lungs and a ruptured hydatid cyst in eight cases. Lobectomy was the most frequent applied procedure [100%]. Two [20%] cases died due to blood aspiration and respiratory distress syndrome, one in the 3rd and the other in the 4th postoperative day. The postoperative hospital stay ranged between 7 and 25 [mean 11.30 +/- 6.56] days. Two and a half years follow-up of patients was good. There was no recurrence. There were significant differences between the two groups In terms of complications and mortality [X2 =102.39, df=1, p<0.0005] and [X2 = 5.82, df=1, p<0.16]. Massive life-threatening hemoptysis due to pulmonary hydatid cysts must be managed as an urgent clinical entity. It has serious symptoms, serious post-operative complications and a high mortality rate.

Comparison of pulmonary hydatid disease between children and adults

Hydatid disease is a parasitic infestation which is endemic in many sheep and cattle raising areas and is still an important health hazard in the world. The aim of this study was to compare the clinical features, radiologic accuracy, and the surgical approaches of pulmonary hydatid cysts among children and adults in Northwestern Iran. 445 patients treated for pulmonary hydatid cysts over the last ten years, were retrospectively evaluated. The patients were arranged in two groups. There were 383 adults [86%] and 62 children [14%] and their clinical, radiological and surgical characteristics of the pulmonary hydatid cysts were compared. Unlike adults, in children the frequency of pulmonary hydatid cysts in males was significantly [p=0.0036] higher than in females [65% vs. 36%]. Cough was the most common symptom in both groups. The frequency of hemoptysis was more common [p=0.0042] in adults [38%] than in children [19%]. However, giant pulmonary hydatid cysts were more commonly found in children [p < 0.05]. Cystotomy with or without capitonnage was the most preferred method used in both groups. Postoperative complications [pneumothorax] developed in five adults and one child, and were more frequent in noncapitonnage procedures. Only one recurrence was observed in the adult group. The accuracy of chest x-ray was 84% and 74% in children and adults, respectively. Due to the high accuracy of chest x-ray in diagnosis of hydatid cysts of the lung in both groups, it is recommended as the preferred method of diagnosis in endemic regions

Inflammatory pseudotumor of the lung: report of four adult cases

Inflammatory pseudotumors of the lung are rare and may produce diagnostic and therapeutic dilemma for the clinicians, pathologists, and surgeons. Herein, we reported on four patients with this uncommon disease. They were three men and one woman with a mean age of 37 years [range: 20 - 50]. Three cases were symptomatic, complaining of cough, expectoration of sputum, hemoptysis, and chest pain. Three had solitary pulmonary nodule [SPN] and one had a tumor-like mass in chest X-ray films. Wedge resection was performed for the first three cases. With suspicion of lung cancer, pneumonectomy was carried out for the last patient. The overall survival was 100%. There was no operative or postoperative complications/death or recurrence within 5 - 10 years of follow-up. All of them had benign appearances, which was proven by pathologic examination. Inflammatory pseudotumors of the lung are rare. Most behave in a benign fashion. It may increase slowly in size and sometimes has an aggressive behavior. Frozen section may be used during the operation for the diagnosis. According to pathologic examination, complete resection is safe and leads to excellent survival