Shubham Gupta, MS, Gagandeep Talwar, Jasmine Agarwal, Ajay Bhandarwar, MS, Amol Wagh, MS, Saurabh Gandhi, MS. Grant Government Medical College & Sir JJ Group of Hospitals, India
Introduction: Hydatidosis is a zoonotic disease caused by Echinococcus granulosus. It is endemic in the Mediterranean, South America and middle east. It is a systemic disease wherein lungs are the second most common organ involved, after liver. Radio-imaging plays an important role in diagnosing and determining the extent of the disease. Surgical enucleation of cyst has been the classical treatment for this disease. Bilateral lung involvement has been traditionally treated by median sternotomy or a bilateral thoracotomy. Video assisted thoracoscopic surgery (VATS) is an effective surgical approach in such settings.
Materials & Methods: At our center, we have operated 67 cases of pulmonary hydatidosis thoracoscopically over the past 3 years. In all cases, area around the cyst was cordoned off with 0.5% Cetrimide soaked gauze pieces. A pericystotomy is performed with ultrasonic shears & the germinal membrane is delivered en masse into an endo-bag. An air leak test after saline instillation into the cavity, is a standard part of the procedure.
For those cases with cysto-bronchiolar communications, the defect was sealed by either suturing or glue application.
Traditionally, bilateral cases & cysts larger than 10cm in size were tackled by an open approach. But, in our experience, cyst size, bilaterality & presence of complications are not contraindications for VATS.
All cases are administered perioperative albendazole (400 mg twice a day, administered for three cycles of 21 days each, with a gap of 7 days in between) which helps in preventing recurrence and also takes care of any inadvertent intra-operative spillage.
Conclusion: Traditionally, bilateral cases & cysts larger than 10cm in size were tackled by an open approach. But, in our experience, cyst size, bilaterality & presence of complications are not contraindications for VATS.
Pulmonary hydatidosis can be treated by VATS in a safe and effective manner. Our literature review has revealed that ours was the first instance where bilaterally pulmonary hydatid cysts were treated in a single sitting thoracoscopically.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87271
Program Number: P691
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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