Thoracic approach for hepatic hydatid cyst: Surgical outcomes and post-operative results

Résumé fourni par la source

Introduction: Liver hydatid disease (HCL), caused by Echinococcus granulosus, is a common parasitic infection in Tunisia. While most liver hydatid cysts are approached via laparotomy, thoracotomy remains a valuable surgical approach for selected HCL, particularly those involving the liver dome or extending into the thoracic cavity. Methods: This is a retrospective descriptive study carried out in our departement over a period of 6 years. We included all patients operated on for hepatic hydatid cyst via the trans-diaphragmatic approach. Results: We collected 49 patients. The average age was 52.1 years ± 19.1. The sex-ratio was 0.96. The trans-diaphragmatic approach was indicated in 25 cases for thoracic migration of the HCL, in 11 cases for association of right lung HC and HCL of the dome, in 8 cases for ease of access and in 5 cases for recurrent HCL. For 22 patients (44.9%), a diaphragmatic fistula was found. For the treatment of HCL, 41 cystectomies and 8 pericystectomies were performed. Twelve lung resections, 8 cures of secondary pleural hydatidosis and 4 pleural decortications were performed in cases of thoracic migration of HCL. Postoperatively, hospital stay was on average 3.6 ± 2.5 days. Only one death occurred following septic shock. The morbidity rate was 16.4%. The two main complications were prolonged bile leak (n=3) and wall infection (n=3). Conclusion: The trans-diaphragmatic approach in dome HCL surgery is a reliable, effective and relatively simple technique. It allows direct access to echinococcal lesions with very good exposure. The choice of this path should be the decision of a multi-disciplinary consultation in order to offer the best approach to the patient.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.