Methods of surgical therapy in pulmonary hydatid disease: is capitonnage advantageous?

BACKGROUND: Hydatid disease of the lungs is still a serious health problem for some Mediterranean countries. The best surgical therapy for the treatment of this disease is still unclear. In this clinical retrospective study, we aimed to investigate whether capitonnage is an effective therapy method for a pulmonary hydatid cyst or not. METHODS: Between 1990 and 2004, 89 patients (49 male and 40 female) each with a pulmonary hydatid cyst were treated surgically. The patients were divided into two groups based on whether capitonnage was carried out (group 1, n = 44) or not (group 2, n = 45). Cystotomy and the closure of the bronchial openings were carried out in both groups. The results were assessed in two groups during a 1 year follow-up period. The groups were comparable with regards to their clinical, operative and demographic characteristics. RESULTS: There was no mortality, and no significant difference in hospitalisation time between the two groups. It was 8.2 +/- 3.2 days for group 1 and 8 +/- 3.1 days for group 2 (P = 0.89). The most serious complications were restricted bronchopleural fistula (only one patient in group 2), empyema (only one patient in group 1 and two patients in group 2), and prolonged air leak (five patients in group 1 and six patients in group 2). These results were not valuable statistically (P = 1.00, P = 1.00 and P = 0.78, respectively). CONCLUSIONS: We conclude that it is not an advantage to carry out capitonnage when treating pulmonary hydatid cysts.

One-stage transthoracic operation for the treatment of right lung and liver hydatid cysts.

In this study we reviewed our experience of hydatid disease of the lung and the liver and discussed the safety and the follow-up results of the one-stage operation. Between 1990 and 2004, 142 patients with pulmonary hydatid disease underwent operation in our clinic. Of these, 27 (19%) patients had cysts located on the dome of the liver, treated with phrenotomy through a right thoracotomy. Hydatid cysts located in the lungs were managed by means of cystotomy. For liver cysts, cystotomy and the inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. The pulmonary cysts of 12 (8.4%) patients were bilateral and 5 (3.5%) patients had prior surgical treatment of hepatic (n = 1) or pulmonary (n = 4) hydatid cysts. The liver cysts were approached transdiaphragmatically after the lung cysts were excised in 27 (19%) patients. In patients with pulmonary cysts, cystotomy, with or without capitonnage was performed on 123 (86.6%) patients, and wedge resection was performed on 11 (7.7%), segmentectomy was performed on 6 patients (4.2%), and lobectomy was performed on 2 (1.4%) patients. There was no mortality, and only a small number of complications were encountered: empyema in 3, excessive biliary drainage in 2, and bronchopleural fistula in only 1. We suggest that the extraction of pulmonary and hepatic cysts simultaneously through the transthoracic route is a useful and safe surgical technique. This technique also prevents the need for a second operation.

Tracheal stenosis aftertracheostomy or intubation: review with special regard to cause and management.

To investigate the management outcomes of patients who developed tracheal stenosis after tracheostomy or intubation, we reviewed the courses of 45 patients who had experienced tracheal stenosis at a single institution, over 19 years from February 1985 through January 2004. There were 38 tracheal and 7 infraglottic stenoses. Twenty-nine stenoses were associated with the stoma, 12 with the cuff, and 2 with the endotracheal tube resulting in infraglottic lesions; the remaining 2 were double stenoses. Eleven patients were treated by bronchoscopic surgery, and 34 patients were treated by tracheal or laryngotracheal resection. The overall success rate was 93%. The complication rate was 18%. A 2nd operation was required in 3 patients, and 1 of the 3 died of sepsis. Our management strategy of treating tracheal stenosis with resection and end-to-end anastomosis has been associated with good outcomes. Management of infraglottic stenosis is difficult, particularly when there is a large laryngeal defect or when there have been previous surgical attempts at the same site.

Bronchogenic cyst.

The clinical presentation of the bronchogenic cyst is variable, from respiratory distress at birth to late appearance of symptoms. In order to determine clinical features and treatments, we retrospectively studied the medical records and pathology reports of all patients with bronchogenic cysts (n = 22) referred to our surgical department from February 1985 through January 2002. They included 18 male and 4 female patients with an age range of 1 to 38 years (average, 16.4 years). There were 14 mediastinal, 2 hilar, and 6 intrapulmonary bronchogenic cysts. Symptoms were present in 18 of the 22 patients. Cough was the most common symptom (45%). Ten patients (45%) presented with complications: severe hemoptysis, pneumothorax and pleuritis, esophageal compression, infected cyst, and postobstructive pneumonia. In all patients, complete resection of the bronchogenic cyst was performed by thoracotomy A postoperative sequela occurred in only 1 patient, who had a persistent air leak. There were no late sequelae, nor was there a recurrence of the cyst. The follow-up period ranged from 8 months to 12 years (mean, 5.2 years). Because a confident preoperative diagnosis is not always possible and because complications are common, we recommend surgical resection of all suspected bronchogenic cysts in operable candidates.

Early and long-term results of surgical repair of pectus excavatum.

From 1990 to 1998, 30 patients underwent surgery for correction of pectus excavatum. There were 19 (63%) males and 11 (37%) females, aged 4 to 32 years (mean, 12.57 years). Bilateral excision of 4 to 6 costal cartilages and sternal wedge osteotomy were performed on 27 (90%) patients, and Kirschner wires were used for substernal support in 25 (83%). A median sternotomy was carried out in males and a submammary transverse incision was preferred in females. All patients were followed up at yearly intervals. Early results were excellent in all except 2 cases: a 14-year-old boy developed contralateral sternal depression after costochondral excision without sternal elevation for correction of one-sided costochondral hyperplasia; and an 8-year-old girl in whom no Kirschner wires had been inserted developed recurrent minimal sternal depression. Long-term follow-up showed recurrent sternal depression 6 years postoperatively in a boy who had undergone surgery at 4 years old, with early removal of the Kirschner wires. It is recommended that correction of pectus excavatum should be carried out in prepubertal children, and Kirschner wires should be used for substernal support.