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jsmc-10054


OUTCOME OF CAPITONNAGE IN MANAGEMENT OF PULMONARY HYDATIDOSIS


Aram Baram * and Saffa H. Al Ali **


*  Department of Surgery, School of Medicine, Faculty of Medical Sciences, University of Sulaimani. 
** Karbala Directorate of Health, Safir Al Hussain Hospital for Surgical Specialties, Karbala, Iraq.


Submitted: 24/9/2013; Accepted: 24/11/2013; Published 1/12/2014


ABSTRACT

Background 

Pulmonary hydatidosis is an endemic disease in Iraq. The treatment of choice for pulmonary hydatid disease (PHD) is surgical. The the aims of surgery are evacuation of cyst contents, closure of bronchial openings, and prevention of intra-operative soiling. The management of residual cyst cavity is controversial and the majority of surgeon recommend leaving the cavity open. However, others prefer to close it by capitonnage.

Objectives

The objective of this study was to assess the outcome and safety of capitonnage in surgery of pulmonary hydatid cyst and comparing our results with the relevant literature.

Patients and Methods

Seventy two patients with diagnosis of PHD (simple or complicated) admitted to our institution from November, 1st 2010 to July, 1st 2013. The demographic and clinical features were recorded. Diagnostic work-up was clinical, plain chest X-rays aided by CT scan of the chest and bronchoscopy in doubtful cases. Serological tests were not done routinely. In all patients the residual cavity of the cyst was closed by capitonnage using a series of purse-string Vicryl sutures from the bottom outwards.

Results

The cysts were intact in 38 patients (52.17%) and ruptured in the remaining 34 (47.83%). lung parenchyma preserving techniques were used in all patients except one (1.4%) who had lobectomy. All patients run a smooth postoperative course except  five (6.9%) who developed prolonged air leak (n=1), empyema (n=2), empyema and pneumothorax (n=1) and one case of recurrence (1.4%). There was no mortality.

Conclusions

The results of capitonnage procedure in this series were superior to studies in which the cyst cavity was left open with lower complication and reoperation rates.

KEYWORDS

PHD, Echinococcosis, Lung preserving surgery, Capitonnage, Morbidity.

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