Surgical treatment of pulmonary hydatid disease: a nine-year single-center experience

Abstract

Introduction: Hydatidosis is one of the most critical parasitic zoonotic diseases worldwide. Lungs are the second most common site of the disease. Aim: This study aimed to evaluate the clinical presentation, diagnosis, radiological findings, surgical treatment and post-operative complications of pulmonary hydatid cyst in patients referred to the Second Surgery Clinic at St George University Hospital in Plovdiv, Bulgaria. Materials and methods: From January 2014 to December 2022, 69 patients were operated on due to pulmonary hydatidosis in the Clinic of Thoracic and Abdominal Surgery at St George University Hospital in Plovdiv, Bulgaria. Demographic data of the patients were collected including clinical symptoms, laboratory studies, radiological findings, location of the lung involvement, and surgical procedures and post-operative complications were recorded. Results: Pulmonary hydatidosis was confirmed for 69 (46 male and 23 female) patients. The average age of the study group was 31.59±19.49 years. In 29 of the tested patients, specific antibodies of the IgG class to Echinococcus granulosus were positive, and 23 patients showed negative results. The leading symptom was non-productive cough followed by shortness of breath, chest pain, fever, productive cough; rash was reported in one patient. 91.3% of the cases presented with a typical X-ray image and in 8.7% it was atypical. It turned out that 66.7% of patients with an atypical X-ray findings developed complications in the postoperative period. Right lung was affected in 50.7% of the cases. The average size of the echinococcal cyst was 7.43±3.23 cm. Statistical analysis revealed a correlation between the size of the hydatid cyst and the length of the postoperative period. Dissemination in other organs was found in 16 of the patients. No statistically significant differences were reported in the patients with dissemination, regarding the size of the primary hydatid cyst, complications and duration of the postoperative period. The preferred methods of approach were thoracotomy and VATS. The most commonly performed surgical technique was echinococcectomy and capitonnage a modo Delbet followed by two lobectomies and one wedge resection. The mean postoperative period was 7.00±2.81 days. In 12 of the analyzed patients, complications occurred in the postoperative period, and mortality was reported in one patient. Conclusion: Pulmonary echinococcosis remains a significant health issue in many countries worldwide including Bulgaria. With a prolonged silent period, it is usually diagnosed when clinical symptoms as cough, dyspnea, chest pain and fever start manifesting. Plain chest radiography remains the basic imaging method for initial diagnosis while ELISA test has limited diagnostic accuracy in cases of pulmonary hydatidosis. Irrelevant to surgical approach, Delbet’s capitonnage procedure is associated with good postoperative results and low complication rates.