Skip to main content

Advertisement

SpringerLink
Log in

Thoracic hydatid cysts: an analysis of surgical management in a tertiary care centre in India

  • Original Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Introduction and purpose

Though hydatidosis is a ubiquitous zoonosis endemic to India, there is a dearth of literature regarding the management of thoracic hydatid disease (THD) in India. There are no surgical guidelines available. The aim of this study is to analyse the details of THD operated upon in a tertiary care hospital in India and propose a protocol for its management.

Methods

The case files of all adult patients operated upon for THD in our institution between 2009 and 2019 were retrieved and a retrospective study done.

Results

A total of 186 patients, 103 (55.4%) males and 83 (44.6%) females, with a mean age of 34.2 years were studied. The commonest symptom was cough as in 83 (44.6%) patients. Complications were seen in 22 (11.8%) patients. Computerized tomogram (CT) was confirmatory in most patients. Isolated pulmonary disease was seen in 135 (72.6%) patients with 153 (82.3%) uni-lobar involvement. Right lower lobe was most frequently involved as in 56 (30.1%). Extra-pulmonary, intra-thoracic involvement was seen in 6 (3.2%) and synchronous extra-thoracic disease in 45 (24.2%) patients. All patients were initiated on anthelmintics. Postero-lateral thoracotomy was the commonest surgical approach. Twenty (10.7%) patients required lung resections. The mean hospital stay was 5.9 days. Air leak, seen in 10 (5.4%) patients, was the commonest post-operative complication. There was single in-hospital mortality. Age, diabetes mellitus, secondary bacterial infection of the cyst and cyst characteristics were found to significantly affect the surgical outcomes.

Conclusion

Surgery, the treatment of choice for THD, can be done with negligible morbidity and mortality and should be expedited to prevent complications. Risk factors should be identified pre-operatively for better decision-making. Adequate concurrent medical therapy may prevent recurrences. Prolonged follow-up is mandatory to detect late recurrences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Sotiraki S, Himonas C, Korkoliakou P. Hydatidosis-echinococcosis in Greece. Acta Trop. 2003;85:197–201.

    Article  CAS  Google Scholar 

  2. Doğan R, Yüksel M, Cetin G, et al. Surgical treatment of hydatid cysts of the lung: report on 1055 patients. Thorax. 1989;44:192–9.

    Article  Google Scholar 

  3. Malla N, Mewara A. Human cystic echinococcosis with special reference to India – an overview. Ann Clin Cytol Pathol. 2016;2:1038.

    Google Scholar 

  4. Sarkar M, Pathania R, Jhobta A, Thakur BR, Chopra R. Cystic pulmonary hydatidosis. Lung India. 2016;33:179–91.

    Article  Google Scholar 

  5. Kayal A, Hussain A. A comprehensive prospective clinical study of hydatid disease. ISRN Gastroenterol. 2014;2014:514757.

  6. Morar R, Feldman C. Pulmonary echinococcosis. Eur Respir J. 2003;21:1069–77.

    Article  CAS  Google Scholar 

  7. Manzano-Román R, Sánchez-Ovejero C, Hernández-González A, Casulli A, Siles-Lucas M. Serological diagnosis and follow-up of human cystic echinococcosis: a new hope for the future? Biomed Res Int. 2015;2015:428205.

  8. Lichter I. Surgery of pulmonary hydatid cyst-the Barrett technique. Thorax. 1972;27:529–34.

    Article  CAS  Google Scholar 

  9. Esteva H. Alejandro Posadas, Argentinian pioneer: thoracic surgery in the Western world in his time. Ann Thorac Surg. 2004;78:741–5.

    Article  Google Scholar 

  10. Mohapatra B, Sivakumar P, Bhattacharya S, Dutta S. Surgical treatment of pulmonary hydatidosis: a single-centre experience of four years. Indian J Thorac Cardiovasc Surg. 2015;31:8–12.

    Article  Google Scholar 

  11. Arinc S, Kosif A, Ertugrul M, et al. Evaluation of pulmonary hydatid cyst cases. Int J Surg. 2009;7:192–5.

    Article  Google Scholar 

  12. Harris DG, Van Vuuren WM, Augustyn J, Rossouw GJ. Hydatid cyst fistula into the aorta presenting with massive hemoptysis Case report and literature review. J Cardiovasc Surg (Torino). 2001;42:565–7.

    CAS  Google Scholar 

  13. Gursoy S, Ucvet A, Tozum H, Erbaycu AE, Kul C, Basok O. Primary intrathoracic extrapulmonary hydatid cysts: analysis of 14 patients with a rare clinical entity. Tex Heart Inst J. 2009;36:230–3.

    PubMed  PubMed Central  Google Scholar 

  14. Gandhi S, Das B, Basu R, Dey S. Single-centre experience in treatment of multiple-site hydatid disease in a tertiary care centre of Eastern India. Indian J Thorac Cardiovasc Surg. 2019;35:461–7.

    Article  Google Scholar 

  15. Tuncer E, Tas SG, Mataraci I, et al. Surgical treatment of cardiac hydatid disease in 13 patients. Tex Heart Inst J. 2010;37:189–93.

    PubMed  PubMed Central  Google Scholar 

  16. Tandur R, Irodi A, Chacko BR, Vimala LR, Christopher DJ, Gnanamuthu BR. Magnetic resonance imaging as an adjunct to computed tomography in the diagnosis of pulmonary hydatid cysts. Indian J Radiol Imaging. 2018;28:342–9.

    Article  Google Scholar 

  17. No authors listed. Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ. 1996;74:231–42.

  18. Usluer O, Kaya SO, Samancilar O, Ceylan KC, Gursoy S. The effect of preoperative albendazole treatment on the cuticular membranes of pulmonary hydatid cysts: should it be administered preoperatively? Kardiochir Torakochirurgia Pol. 2014;11:26–9.

    PubMed  PubMed Central  Google Scholar 

  19. Cobo F, Yarnoz C, Sesma B, et al. Albendazole plus praziquantel versus albendazole alone as a pre-operative treatment in intra-abdominal hydatisosis caused by Echinococcous granulosus. Trop Med Int Health. 1998;3:462–6.

    Article  CAS  Google Scholar 

  20. Besim H, Karayalçin K, Hamamci O, Güngör C, Korkmaz A. Scolicidal agents in hydatid cyst surgery. HPB Surg. 1998;10:347–51.

    Article  CAS  Google Scholar 

  21. Momblano P, Pradere B, Jarrige N, Concina D, Bloom E. Metabolic acidosis induced by cetrimonium bromide. Lancet. 1984;2:1045.

    Article  CAS  Google Scholar 

  22. Baraka A, Wakid N, Yamout F. Methemoglobinemia during surgical excision of hydatid cyst. Middle East J Anaesthesiol. 1980;5:509–13.

    PubMed  CAS  Google Scholar 

  23. Tripathy S, Sasmal P, Rao PB, Mishra TS, Nayak S. Cetrimide-chlorhexidine-induced multiorgan failure in surgery of pulmonary hydatid cyst. Ann Card Anaesth. 2016;19:557–60.

    Article  Google Scholar 

  24. Petrov DB, Terzinacheva PP, Djambazov VI, et al. Surgical treatment of bilateral hydatid disease of the lung. Eur J Cardiothorac Surg. 2001;19:918–23.

    Article  CAS  Google Scholar 

  25. Denis B, Chevret R, Boujibar M, Kari P, Alaoui A. Surgical treatment of hydatid cyst of the lung. Apropos of 573 cases. Ann Chir Thorac Cardiovasc. 1969;8:189–96.

  26. Galindo R, Cherkaoui O, Abdelaoui A, Bennis A, Biaz A, Laraki A. Treatment of pulmonary hydatid cysts in children. Ann Chir. 1981;35:213–5.

  27. Turna A. Minimally invasive approach for pulmonary hydatid cyst. J Vis Surg. 2019;5:16.

    Article  Google Scholar 

  28. Vuitton DA. Benzimidazoles for the treatment of cystic and alveolar echinococcosis: what is the consensus? Expert Rev Anti Infect Ther. 2009;7:145–9.

    Article  CAS  Google Scholar 

  29. Ahmadinejad M, Hashemi M, Azizallahi N. Evaluation of prognostic factors associated with postoperative complications following pulmonary hydatid cyst surgery. Open Respir Med J. 2020;14:16–21.

    Article  Google Scholar 

  30. Lazarus DR, Casal RF. Persistent air leaks: a review with an emphasis on bronchoscopic management. J Thorac Dis. 2017;9:4660–70.

    Article  Google Scholar 

  31. Athanassiadi K, Kalavrouziotis G, Loutsidis A, Bellenis I, Exarchos N. Surgical treatment of echinococcosis by a transthoracic approach: a review of 85 cases. Eur J Cardiothorac Surg. 1998;14:134–40.

    Article  CAS  Google Scholar 

  32. Tor M, Atasalihi A, Altuntas N, et al. Review of cases with cystic hydatid lung disease in a tertiary referral hospital located in an endemic region: a 10 years’ experience. Respiration. 2000;67:539–42.

    Article  CAS  Google Scholar 

  33. Levy N, Dhatariya K. Pre-operative optimisation of the surgical patient with diagnosed and undiagnosed diabetes: a practical review. Anaesthesia. 2019;74:58–66.

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Aamir Mohammad, Santhosh Regini Benjamin, Deepak Narayanan, Vinay Murahari Rao, Sameer Malampati, Shalom Sylvester Andugala, Nishok David & Birla Roy Gnanamuthu

Authors
  1. Aamir Mohammad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Santhosh Regini Benjamin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deepak Narayanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vinay Murahari Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sameer Malampati
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shalom Sylvester Andugala
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nishok David
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Birla Roy Gnanamuthu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Aamir Mohammad and Santhosh Benjamin. The first draft of the manuscript was written by Aamir Mohammad and all authors commented on previous versions of the manuscript. The final manuscript was written by Aamir Mohammad and Birla Roy Gnanamuthu. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Birla Roy Gnanamuthu.

Ethics declarations

Ethics approval

The approval of the institutional review board has been obtained.

Informed consent

Written consent for studies and publication were obtained from the patients prior to the surgery.

Human and animal rights

The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mohammad, A., Benjamin, S.R., Narayanan, D. et al. Thoracic hydatid cysts: an analysis of surgical management in a tertiary care centre in India. Indian J Thorac Cardiovasc Surg 38, 17–27 (2022). https://doi.org/10.1007/s12055-021-01294-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-021-01294-y

Keywords

Search

Navigation