PURPOSE: Surgical treatment of hydatid disease with multivisceral locations may be problematic due to the difficulties problems associated with choosing the best approach and the risk of complication for the second lesion. We report our experience with one-stage surgery.
METHODS: Between 01.01.1985 and 01.01.2007 we treated a total number of 14 patients with hydatid disease located in both lungs or lungs and liver. One-stage surgery was performed in all cases through: succesive bilateral thoracotomy in 6 patients with bilateral pulmonary hydatid cysts (one associated with right phrenotomy for a hepatic hydatid cyst), right thoracophrenotomy for right pulmonary and hepatic hydatid disease in 2 patients, left thoracophrenotomy for left pulmonary and hepatic hydatid disease in 2 patients (one patient with cholecystectomy and transcistic drainage) and thoracotomy with laparotomy through separate incisions in 2 patients. In patients with bilateral pulmonary disease surgery started with the most complicated lesion; in patients with pulmonary and hepatic hydatid disease surgery started with thoracotomy. All the procedures were performed by the same surgical team.
RESULTS: There was no intraoperative accident and no mortality; immediate full-reexpansion of the lungs was achieved in all patients. We encountered no major morbidity, with no need for postoperative mechanical ventilation, prolonged drainage or reoperation. Mean hospitalisation period was 14 days, with no need for any medico-surgical care at the moment of discharge. All patients returned to normal life, with no recurrence at late follow-up (3-20 years).
CONCLUSION: One-stage surgery for hydatid disease with multiple visceral locations appears as a safe approach with no supplementary morbidity or mortality. Use of associated phrenotomy offers an excellent exposure for the hepatic lesion and allows avoidance of a laparotomy in most cases.
CLINICAL IMPLICATIONS: One-stage surgery in patients with hydatid disease with multivisceral locations offers important advantages: one anesthesia, one surgical procedure, no risk for evolutive complications for the second hydatid cyst and reduced hospitalisation with lower costs.
DISCLOSURE: Alexandru Botianu, None.