Evaluating Giant Hydatid Cysts: Factors Affecting Mortality and Morbidity.

OBJECTIVE: The aim of this study was to evaluate the prognostic factors affecting morbidity and mortality among patients who underwent surgery for giant pulmonary hydatid cysts in our center. METHODS: Data from 283 patients who underwent surgery in our center for pulmonary hydatid cyst between 2008 and 2018 were retrospectively analyzed. Cysts 10 cm in diameter or larger were considered giant hydatid cysts. RESULTS: There were 145 women (51.2%) and 138 men (48.8%). Giant cyst (≥10 cm) was present in 57 patients (20.1%), while the other 226 patients (79.9%) had cysts smaller than 10 cm. Operations were performed using videothoracoscopic approach in 68 patients (24%) and with thoracotomy in 215 patients (76%). Hydatid cysts were on the left side in 129 patients (45.6%), on the right side in 143 patients (50.5%), and bilateral in 11 patients (3.9%). Postoperative morbidity occurred in 29 patients (10.2%). Use of videothoracoscopic surgical approach did not affect morbidity. The mortality rate within the first 90 days was 0.35% (n = 1). CONCLUSION: Giant cysts are more common in the young age group than in older adults. Regardless of cyst size, surgery should be performed as soon as possible after diagnosis to avoid potential complications.

Hidatidosis pulmonar: hallazgos y tratamiento quirúrgico en quistes complicados versus no complicados / Pulmonary hydatidosis: findings and surgical treatment in complicated versus uncomplicated cysts

Resumen Introducción: La hidatidosis humana es una zoonosis prevalente en nuestro medio, causada principalmente por el parásito Echinococcus granulosus. Las complicaciones más frecuentes en el pulmón son la rotura y la infección del quiste. Objetivos: Describir y comparar características clínicas, tratamiento, morbilidad y mortalidad de los pacientes hospitalizados por quiste hidatídico pulmonar (QHP) complicado versus no complicado. Materiales y Método: Estudio analítico longitudinal. Período enero de 1973 - diciembre de 2017 en Hospital Clínico Regional de Concepción "Dr. Guillermo Grant Benavente", Chile. Revisión de base de datos, protocolos de QHP y fichas clínicas. Se utilizó planilla Microsoft Excel® y programa SPSS24®, con función chi cuadrado y t de Student. Se consideró significativo p < 0,05. Resultados: Total 364 episodios de QHP, complicados 179 (49,2%) versus no complicados 185 (50,8%). Edad promedio 36,4 ± 18,9 versus 32,4 ± 19,1 años, hombres 114 (63,7%) versus 107 (57,8%), respectivamente. Se encontró diferencia estadísticamente significativa en: sintomatología tos 147 (82,1%) versus 120 (64,9%), hemoptisis 93 (52,0%) versus 45 (24,3%), respectivamente; QHP derecho 115 (64,2%) versus 99 (53,5%), respectivamente; cirugía conservadora 139 (77,7%) versus 167 (90,3%), reoperaciones 22 (12,3%) versus 8 (4,3%), respectivamente; morbilidad 47 (26,3%) versus 30 (16,2%), mortalidad 6 (3,4%) versus 0 (0%), estadía hospitalaria postoperatoria promedio 16,1 ± 14,3 versus 10,7 ± 7,7 días, recidivas 15 (8,4%) versus 13 (7,0%), respectivamente. Discusión: Aproximadamente la mitad de los QHP son complicados. Los QHP complicados presentan diferencias estadísticamente significativas en su clínica, tratamiento, morbilidad, mortalidad y estadía hospitalaria postoperatoria.

Background: Human hydatidosis is a prevalent zoonosis in our environment, caused mainly by the Echinococcus granulosus parasite. The most common complications in the lung are cyst rupture and infection. Aim: To describe and compare clinical characteristics, treatment, morbidity and mortality of patients hospitalized for complicated versus uncomplicated hydatid pulmonary cyst (HPC). Materials and Method: Longitudinal analytical study. Period January 1973 - December 2017 at the Regional Clinical Hospital of Concepción "Dr. Guillermo Grant Benavente", Chile. Database, prospective protocols and medical records were reviewed. Microsoft Excel® spreadsheet and SPSS24® program with chi square and Student's t-test were used. It was considered significant p < 0.05. Results: Total 364 episodes of HPC, complicated 179 (49.2%) versus uncomplicated 185 (50.8%). Average age 36.4 ± 18.9 versus 32.4 ± 19.1 years, male 114 (63.7%) versus 107 (57.8%), respectively. A statistically significant difference was found in: symptomatology cough 147 (82.1%) versus 120 (64.9%), hemoptysis 93 (52.0%) versus 45 (24.3%), respectively; HPC right 115 (64.2%) versus 99 (53.5%), respectively; resective cyst surgery 139 (77.7%) versus 167 (90.3%), reoperation 22 (12.3%) versus 8 (4.3%), respectively; morbidity 47 (26.3%) versus 30 (16.2%), mortality 6 (3.4%) versus 0 (0%), average postoperative hospital stay 16.1 ± 14.3 versus 10.7 ± 7.7 days, recurrence 15 (8.4%) versus 13 (7.0%), respectively. Conclusions: Approximately half of the HPCs are complicated. Complicated HPCs present statistically significant differences in their clinical, treatment, morbidity, mortality and postoperative hospital stay.

Hepatic Echinococcosis with Thoracic Involvement. Clinical Characteristics of a Prospective Series of Cases.

INTRODUCTION: Thoracic involvement (TIHE) is one of the evolutionary complications of hepatic echinococcosis (HE). AIM: The aim of this study was to describe the clinical characteristics and postoperative morbidity (POM) of a series of patients with TIHE treated surgically. MATERIAL AND METHODS: Series of cases of patients treated for TIHE between 2000 and 2014 in the Hospital Regional and Clínica Mayor in Temuco, Chile, with a minimum 12-month follow-up. The outcome variable was "development of POM". Descriptive statistics were used. RESULTS: The series was composed of 37 patients with a mean age of 53.2 ± 47.4 years (51.4% female). Mean cyst diameter was 19.4 ± 15.5 cm, and 75.7% of the lesions were located in the right hepatic lobe. The most frequent surgical technique used for the cyst was subtotal pericystectomy (56.8%); the residual cavity was treated by capitonnage (27.0%) or omentoplasty (21.6%), and a phrenoplasty with or without prosthetic material was performed for the TIHE. Mean hospital stay was 6.0 ± 5.7 days and follow-up was 61.4 ± 79.9 months; a mortality rate of 2.7% (one patient) and a POM of 24.3% (9 patients) were verified. CONCLUSION: TIHE is an uncommon evolutionary complication of HE associated with significant POM rate.

[Diagnostics and surgery of combined lung echinococcosis].

An analysis of surgical treatment of 162 patients with lung echinococcosis was made. The main group consisted of 74 patients with combined forms of echinococcosis of the lung and other organs. They were treated in clinic in the period of time since 1982 till 2011 years. The control group included of 88 patients with echinococcosis of lung and the patients were followed-up in the period of time since 1991 till 2000. Plasma technology was applied in all patients of control group. The patients from main group (25) were operated by using the conventional methods and 49 patients - with the application of plasma technology. An analysis shows a reliable reduction of the rate of postoperative complications after application of plasma technology in 4 times. The lethality significantly decreased in this group of patients.

Pulmonary hydatid cyst: analysis of 1024 cases.

PURPOSE: Pulmonary hydatid cyst, a parasitic disease, is a health care problem in developing countries. In this study, we evaluated outcomes of patients with pulmonary hydatid disease who were treated in our department. METHODS: Patients admitted with a pulmonary hydatid cyst from 1981 to 2008 were enrolled in this study. Their demographic data, the sites and number of cysts, diagnostic methods, type of operation, outcomes, and recurrence rate were statistically analyzed. RESULTS: Among the 1024 patients, the mean±SD age was 30.6±16.1 years, and the male/female ratio was 1.09. The most common symptom was a cough (55.1%). Only 1% of the patients were asymptomatic. Altogether, 53.8% had right-side involvement, 40.0% had left-side involvement, and 6.2% had bilateral disease. The inferior lobe was the lobe most common involved. The cyst was intact in 539 (52.6%) patients; and the others were complicated or perforated. The most common surgical technique entailed removing the cyst membrane without resecting the pericyst and closing the airways (67.2%). The cyst was enucleated in 21.2%; and parenchymal resection was performed in 10.3%. The mortality rate was 0.2%, and morbidity occurred in 8.4% of patients. The most common complications were residual spaces with prolonged air leak and wound infection. The recurrence rate was 2.5%, with most of the recurrences (82.6%) managed by surgery. CONCLUSION: The best treatment for pulmonary hydatid cyst disease is surgery, which is associated with low mortality and morbidity rates. The most common and acceptable treatment is extraction of the cyst membrane without manipulating the pericyst and closure of small airways. Pulmonary resection should be reserved for complicated forms of the disease.

Need for lung resection in patients with intact or ruptured hydatid cysts.

BACKGROUND: Lung hydatid cyst caused by Echinococcus granulosus is endemic in many areas of the world. We aimed to compare the outcome of surgical treatment in intact and ruptured (infected or noninfected) cysts. METHODS: We reviewed the medical records of 115 patients with lung hydatid disease who were surgically treated between 2001 and 2005 in a tertiary hospital in Lima, Peru. Patients were divided into 3 groups based on cyst characteristics: intact cysts (n = 41), ruptured noninfected cysts (n = 47) and ruptured infected cysts (n = 27). If a patient had more than one type of cyst, the most severe form of disease was recorded. Data related to symptoms, morbidity and mortality were recorded and compared. We also calculated direct patient costs. RESULTS: Mean age of patients was 23.6 +/- 15.1 years old. Ruptured cysts were present in 64 % of patients and giant cysts (> 10 cm diameter) were present in 26 % of patients. Hemoptysis was present in 47.0 % of patients and was more frequent in patients with ruptured infected cysts. Lung resection was performed in 58 % of patients. The most common postoperative complication was infection of the operative wound (6.08 %). Perioperative mortality was zero. Patients with ruptured cysts had a longer hospitalization time and higher total cost (12.28 +/- 0.92 days, US$ 890.34 +/- 303.35) than patients with intact cysts (10.17 +/- 0.79 days, US$ 724.81 +/- 14.38). CONCLUSION: Surgical treatment of lung hydatid disease is safe, with a good outcome and a low mortality rate. The lung resection rate was higher than most published series and reflects the relatively high proportion of patients with giant and ruptured infected cysts.

[Surgical treatment of the combined hydatid disease of liver and lung].

The combined hydatid disease was surgically treated in 101 patients. Among them three groups were distinguished: hydatid disease of the right lung and liver (n=51); bilateral lung and liver affection (n=33); hydatid disease of the left lung and liver (n=17). The method of choice in treatment of the left lung and liver diaphragmatic surface hydatid disease is the one-stage closed echinococcectomy by Delbe. Two- or three-stage operation is indicated in cases of bilateral echinococcosis. The surgical excision should be started from the mostly affected organ or from the site were complications are mostly expected. Patients with the combined hydatid disease of the left lung and liver are to experience the two-stage echinococcectomy. Operations should be performed in the range from 2 to 4 months. The overall lethality of the analyzed cohort was 10,2%.

Parenchyma-saving surgical treatment of giant pulmonary hydatid cysts.

OBJECTIVE: The purpose of this study was to review 97 patients with giant pulmonary hydatid cysts and assess the clinical features and results of different operative techniques over a 27-year period. MATERIAL AND METHODS: Between January 1981 and December 2007, 590 patients were operated on for pulmonary hydatidosis and 97 (17 %) of these patients had giant pulmonary hydatid cyst. We retrospectively reviewed the medical records of these 97 patients. The diameter of the hydatid cysts were measured using radiological methods and intraoperatively. RESULTS: Seventy-eight patients were male (80 %) and 19 were female (20 %). The median age was 23.4 years (range: 15-63 years). The most common symptoms were chest pain (54 %), cough (43 %) and dyspnea (41 %). Fourteen patients were asymptomatic (14 %). The diameters of the cyst ranged between 10 and 25 cm (mean 13.8 cm). The cysts were located in the right hemithorax in 52 (54 %) patients, in the left hemithorax in 44 (45 %) patients and bilaterally in one patient (1 %). Five patients had more than one cyst. The procedures consisted of cystotomy and capitonnage in 53 patients, enucleation and capitonnage in 27 patients and simple cystotomy or enucleation in 8 patients. Anatomical resection was performed in 9 patients. Prolonged air leakage of more than 7 days occurred in five patients; one patient underwent an operation and a Heimlich valve was placed in two patients. There was no postoperative mortality. Recurrence was not detected at follow-up after 6 months and 27 months. CONCLUSION: The higher lung tissue elasticity and delayed symptoms due to localizations of the cyst are the reasons for the occurrence of giant hydatid cysts in the lung. A parenchyma-saving operation should be performed instead of anatomical resection because of the low complication rates and because most complications can be treated conservatively.

Ruptured hydatid cysts of the lung in children: clinical review and results of surgery.

BACKGROUND: Rupture of a hydatid cyst may cause some unique problems, especially in children. METHODS: Sixty-three children with a total of 68 ruptured lung hydatid cysts were operated on between 1980 and 2000. Mean age was 12.3 years (range, 1 to 15 years). Radiographic findings were hydropneumothorax (20.6%) and air-fluid level (19%). Mean follow-up was 19.3 months. RESULTS: Transthoracic needle aspiration was responsible for the rupture in 3 children. The interval between cyst rupture and operation was less than 24 hours in 10 patients (15.9%), 1 to 4 days in 36 (57.1%), and more than 4 days in 17 (27%). Resection rate was 22.1%. The most frequent operative method was cystotomy and capitonnage (38%). Morbidity was 25.4% (extended air leak 5, empyema 3, bronchopleural fistula 3, atelectasis 3, pneumonia 2). Mortality was 4.7% (hemoptysis 1, pneumonia and sepsis 1, aspiration of hydatid material 1). Morbidity and mortality seem to be more frequent in late cases. CONCLUSIONS: Early surgical intervention with single-lung ventilation and maximum parenchyma preservation are recommended.

Thoracic rupture of hepatic hydatidosis (123 cases).

BACKGROUND: Hydatid disease is frequently endemic in countries with poor environmental sanitation and in geographic areas where interaction between humans and animals is common. Pulmonary complications result from the proximity of hydatid cysts in the liver and the diaphragm. METHODS: The medical records of 123 patients, with established hydatid disease manifesting abnormal chest roentgenograms, were retrospectively analyzed for the period January 1990 to December 1999. RESULTS: Chest roentgenogram and abdominal ultrasound provided a correct preoperative diagnosis in 108 patients (87.8%). Expectoration of bile, demonstration of fistula by ultrasound, expectoration of cyst contents, and additional ultrasound or imaging findings were the criteria used to establish the preoperative diagnosis. The remaining 15 cases were confirmed at operation. Men outnumbered women nearly 3:1. Mean age was 36.2 years. Pulmonary resection was performed in 67 cases. Sixty-eight patients presented with a bronchobiliary fistula (55.3%). Morbidity rate was 14.6% and mortality rate was 8.9%. CONCLUSIONS: Thoracotomy offers adequate simultaneous access to both the chest and hepatic lesions with acceptable morbidity and mortality. Endoscopic sphincterotomy undertaken preoperatively is useful in reducing biliary complications.

[Treatment of hydatid echinococcosis]. / Lechenie gitatidnogo ékhinokokkoza.

In Russia the first one-stage operation for hepatic echinococcosis was performed by A.A. Bobrov by his method in 1895. At present there is much experience in surgical treating echinococcosis. With the advent of new ultrasonic diagnostic methods, computed tomography, and new germicide treatment methods have changed. The analysis of 228 patients with echinococcosis treated from 1983 to 1999 was carried out. The traditional surgical interventions were performed in 121 patients; the mortality was 2.5%, the relapse rate 22.3%. Minimum invasive interventions (punctures, hydatid cyst drainage, followed by germicidal treatment) were performed as the only treatment in 68 patients and with subsequent traditional interventions in 22 patients. Experimental studies demonstrated that the retention of gigantic acephalocysts in traditional treatment is the main cause of echinococcal dissemination. 80-100% Glycerin is the most effective germicide. Chemotherapy as the only treatment may be applied only in very minor cysts inaccessible to puncture. A combination of minimum invasive procedures and preoperative (1 course) and postoperative (2-3 courses) chemotherapy is the most effective.

[A universal method to correct underreporting of communicable diseases. Real incidence of hydatidosis in Chile, 1985-1994]. / Un método universal para corregir la subnotificación en enfermedades transmisibles. Incidencia real de la hidatidosis humana en Chile, 1985-1994.

BACKGROUND: There is evidence to postulate that undernotification is the reason for the great decrease in the reported incidence of hydatidosis in Chile. AIM: To develop and propose a method to assess the notification of transmissible diseases, based on observed lethality and hospital discharges. MATERIAL AND METHODS: Human hydatidosis in the period 1985-1994 was used as a model to develop the method. Official reports and mortality were analyzed first, determining the first lethality rate. A second lethality rate was calculated based on hospital discharges and a third, based on all Chilean surgical series published in the last two decades. Adjusting official notification of lethality to the true lethality according to surgical series, the number of unreported cases was calculated and the true incidence of hydatidosis was calculated, summing these cases to the official notification. RESULTS: According to this method, the real rates of human hydatidosis in the period 1985-1994, would fluctuate between 6.5 and 11.4 per 100,000. This figure is four times higher than the official notification in the analysed period. CONCLUSIONS: The correction of under notification based on hospital discharges, with or without correction for repeated hospital admissions, or real mortality of surgical series gave similar results, suggesting that both methods are correct.

Pulmonary hydatidosis: surgical treatment and follow-up of 240 cases.

OBJECTIVE: We review a series of 240 patients treated surgically for pulmonary hydatid cyst in our center between 1966 and 1988, assessing the results with our surgical technique, which involves a novel needle aspiration device designed by Professor D. Figuera, and postoperative treatment protocol. PATIENTS AND METHODS: The majority (60.4%) of the patients were from areas endemic for hydatid disease. The mean age of the patients at the time of the surgical procedure was 31.5 +/- 7.2 years (range: 4-70 years). A trocar-suction device was used for the needle aspiration of 276 (92%) of the 300 cysts encountered in the 240 patients. The remaining 24 cysts were removed integrally by means of different surgical techniques such as cyst enucleation, lobectomy, segmentectomy and atypical pulmonary resection. The residual cavity was treated by pericystectomy and eversion to the pleural surface in 238 cases (86.2%) and by capitonnage in 38 (13.7%). High vacuum suction (-30 cm H2O) was employed in every case. Depending on when the procedure was performed, the patients were treated with mebendazole or albendazole according to the protocol designed by Bekhti. RESULTS: Clinical assessment of the symptoms and plain chest X-ray led to the correct diagnosis in 228 cases (95%). In six (2.5%), imaging studies such as ultrasonography, computed tomography and nuclear magnetic resonance were required, and in the remaining six cases (2.5%), the diagnosis was established intraoperatively or in the subsequent histopathological study. One hundred and seventy patients (70.8%) presented a solitary lung cyst, while the remaining 70 (29.2%) were found to have multiple cysts in one or more lobes of one or both lungs. In addition, 45 patients (18.7%) presented hepatic cysts and 25 (10.4%) had cysts in other locations. After 18 years of follow-up, the survival rate was 94.6%. Of the surviving patients, 98.3% were free of pulmonary hydatid disease and 95.1% were free of hydatid disease. CONCLUSIONS: The trocar-suction device employed here for needle aspiration of hydatid cysts has demonstrated its efficacy in preventing the rupture of the cyst and its possible dissemination. With its use, the parasite is eradicated and the residual cavity can be excised.

Hidatidosis pulmonar: experiencia en 1094 quistes / Hidatid cysts: experience in 1094 cysts

Se analiza la experiencia acumulada en un período de 32 años, en forma retrospectiva, en pacientes intervenidos por hidatidosis pulmonar en el Servicio y Departamento de Cirugía de nuestro Hospital. Se evalúan 1094 quistes hidatídicos pulmonares operados en 825 pacientes entre los años 1964 y 1996, con un 60,7 por ciento de hombres y un 39,3 de mujeres, siendo la edad promedio 36 años. La radiología de tórax continúa siendo el elemento más destacable en el diagnóstico. La endoscopia sólo es útil cuando se ven membranas (4 por ciento). El arco quinto de Caprone posee una muy alta especificidad (99 por ciento), pero la sensibilidad no alcanza al 50 por ciento. La determinación de las inmunoglobulinas G y E tienen una sensibilidad superior (62,5 por ciento) con una especificidad menor (82 por ciento). La localización hepática concomitante se encontró en un 15,1 por ciento. No se encontraron diferencias significativas entre los quistes intactos, simples (54,2 por ciento) y los complicados (45,8 por ciento). Los quistes eran únicos en el 80,1 por ciento, y en el 17,2 por ciento tenían localizaciones múltiples. Los quistes complicados en tránsito hépato-torácico representan el 10 por ciento de las complicaciones y los quistes migrados a pleura el 9 por ciento de ellas. Se realizaron 713 quistectomías (61,5 por ciento), de las cuales las últimas 73 se modificaron adicionándoles el capitonaje. Resecciones pulmonares diversas se efectuaron 374 (32,2 por ciento), siendo la lobectomía la más común (78,8 por ciento). En las 640 quistectomías puras, las complicaciones fueron un 8,7 por ciento, mientras que en las 73 quistectomías modificadas fue 0 por ciento. Las resecciones pulmonares globales presentaron un 6,9 por ciento de complicaciones. La mortalidad (15 casos) fue de 1,8 por ciento

[Treatment of 842 cases with cystic echinococcosis of chest].

842 cases of thoracic echinococcosis were surgically treated by endocystectomy (79%), pneumonectomy (12%), drainage and other operations (9%). Among a total of 1,010 operations, the mortality was 0.6% (5/807). Of 637 cases received 798 endocystectomies, the recurrence rate was 4.2% (27/638). Up to 1979, the first series of 323 cases were followed-up for 3-20 years, no single case died of thoracic echnococcosis. Among the 32 non-operation cases, the mortality was 22.2% (6/27) and 9 cases were spontaneously cured. 22 cases were given praziquantel at two dosages, Group A received 120-150 mg/kg and Group B received 210 mg/kg in divided doses for 5-6 days. The death rate of protoscolices inside the operatively removed cystic fluid from the above two groups was 43.1 +/- 9.6% and 64.2 +/- 3.5%, respectively, while in the untreated Group C 9.2 +/- 2% (P < 0.01). With total dosage of praziquantel 300 mg/kg in divided doses for 7 days, the concentration of praziquantel in patient's blood and cystic fluid was 0.49 +/- 0.075 microgram/ml and 0.006 microgram/ml, respectively.

[The mebendazole treatment of patients with alveolar echinococcosis]. / Lechenie mebendazolom bol'nykh al'veoliarnym ékhinokokkozom.

Chemotherapy was administered to 17 alveolar echinococcosis patients. Two of these patients developed an uncomplicated disease (a subtotal involvement of both liver lobes), fifteen a complicated condition. In 13 patients with the complicated condition metastases to the lungs, peritoneum, as well as diaphragmatic and abdominal organs' growth were detected, in 4 ones jaundice developed. Mebendazole was administered in a daily dose of 50 mg/kg together with the drugs improving its absorption. 30-day courses with 1-3 month intervals were administered. The efficacy of this therapy and its tolerance were assessed from clinical, laboratory and instrumental findings, including serologic tests. Intolerance presenting as alopecia was observed in 4 women, in one of them twice. Mebendazole efficacy in these patients was compared to that in patients administered the drug in a daily dose of 100 mg in 1978-1980. A positive time course was observed in 53% of patients.

Experience in the surgical treatment of 331 patients with pulmonary hydatidosis.

Echinococcus disease is prevalent in Chile, with a rate of occurrence of 8.2 per 100,000. During a 15-year-period (1970 to 1985) we operated on 331 patients for pulmonary hydatidosis. Chest roentgenography was the main method of diagnosis. Among the total of 508 surgical procedures performed, pulmonary cystectomy was the most common (61.4%), whereas pulmonary resection was used in 31.4% of patients. The arc 5 test was used to confirm the diagnosis. Results were positive in 85% of the patients in whom it was done. There were 12.9% immediate postoperative complications in 12.9%, with late complications occurring in 4.10% and an overall mortality rate of 4.21%. These data suggest that hydatid cyst is still a common disease in our country, causing an important number of hospital admissions and a high percentage of complications.

Surgical treatment of hydatid cysts of the lung: report on 1055 patients.

Of 1055 patients treated surgically for pulmonary hydatid disease, most (950) had isolated lung cysts, the other 105 having both liver and lung cysts. The chest radiograph was most valuable in diagnosis; the Casoni and Weinberg tests and blood eosinophil counts were found to be diagnostically unreliable. One thousand and seventy seven primary operations were performed. Cystotomy and capitonnage were carried out in 906 patients, 40 of whom also had decortication of the pleura. Other procedures included cystotomy with wedge resection of locally damaged lung (29 patients) and cyst removal with capitonnage by Ugon's method (33) or the Perez-Fontana procedure (8) and with costal resection for osteomyelitis in two cases. More radical surgery was carried out in 99 patients for longstanding infection or severe lung destruction. Postoperative complications occurred in 37 patients (3.5%) and the 30 day mortality rate was 1.7%. It is concluded that a lung conserving surgical operation is the treatment of choice for most patients with pulmonary hydatid disease. In patients with coexisting liver cysts the thoracic transpleural approach allowed the lung and liver cysts to be removed at the same session.

Thoracic hydatid cysts: a report of 842 cases treated over a thirty-year period.

From 1957 to 1985, 842 patients were diagnosed as having thoracic hydatid cysts; 810 cysts were intrathoracic, 29 occurred on the "liver roof," 2 were cardiac, and 1 was on the chest wall. A total of 1,010 surgical procedures were performed in 807 patients (35 refused operation). There was a total operative mortality of 0.6% (5 deaths). Procedures became more conservative as experience was gained, and 79% of the procedures were endocystectomies. Intact endocystectomy (Barrett's technique) without preliminary aspiration was the approach of choice. Careful protection of the operating field, suturing of all the bronchial openings, and capitonnage were the keys to successful treatment. One hundred six patients with intact endocystectomies done before July, 1975, were followed for 3 to 20 years. Ruptures occurred during cyst manipulation in 35 patients (33%). Recurrence after operation was seen in 2 patients (1.9%). There were no deaths among the patients undergoing intact endocystectomy. In comparison, we followed 136 patients who underwent aspiration endocystectomy and the recurrence rate was 3.7% (5 patients).