Thoracoscopic treatment of pulmonary hydatid cyst in children
Epublication WebSurg.com, Dec 2017;17(12). URL: http://websurg.com/doi/vd01en5142
Introduction: The hydatid cyst is an anthropozoonosis caused by the development of the Echinococcus granulosus tapeworm larva in humans. It is endemic in the Mediterranean, South America, Middle East, Australia, New Zealand, and India. Lung localization is ranked second in order of frequency for all age groups after liver localization. Treatment is mainly surgical and consists in the resection of the protruding dome after cyst puncture, suction, and sterilization using a Scolicide solution followed by proligerous membrane extraction and bronchial fistulas obstruction. This surgery can be performed through a thoracotomy or a thoracoscopy. We report the highlights of a thoracoscopic surgical management of a bilateral pulmonary hydatid cyst in a 6-year-old boy. The cyst was discovered following exploration for chest pain associated with a dry cough, as demonstrated by chest CT-scan findings and confirmed by serum chemistries positive for pulmonary hydatid cyst. Materials and methods: The patient was first operated on for his two hydatid cysts of the right lung, followed by another left-side intervention a month later. Intubation was selective and was performed with a standard intubation cannula. The patient was placed in a strict lateral decubitus position. Four ports (10, 5, 5, and 5mm in size) were used for the right lung and three ports (10, 5, and 5mm) were used for the left lung, making sure to respect the rule of triangulation. After partial filling of the pleural cavity with a 10% hypertonic saline solution, the surgical principles of the thoracoscopic treatment of pulmonary hydatid cysts are performed as follows: puncture of the cyst at its dome using a Veress needle, suction, and sterilization with a 10% hypertonic saline solution for 15 minutes; resection of the protruding dome; extraction of the proligerous membrane through an Endobag®; closure of bronchial fistulas by means of intracorporeal stitches; no padding necessary; double chest drainage (anterior and posterior). Results: Immediate postoperative outcomes were uneventful. Paracetamol was sufficient to manage postoperative pain in the first 24 hours. Chest drains were removed on postoperative day 3, and the patient was discharged on postoperative day 4. After 5 years, late postoperative outcomes were extremely favorable clinically, radiologically, and cosmetically speaking. Conclusion: The thoracoscopic approach to the management of pulmonary hydatid cysts is feasible. It completely changed the postoperative evolution of thoracotomy, which causes pain and parietal sequelae in children.