DIAPHRAGMATIC OR TRANSDIAPHRAGMATIC THORACIC INVOLVEMENT IN HEPATIC HYDATID-DISEASE - SURGICAL TRENDS AND CLASSIFICATION

We performed a retrospective study of 19 patients who had been operate d on for hepatic hydatid disease with diaphragmatic or transdiaphragma tic (D-TD) thoracic involvement chosen from a total of 444 patients wh o underwent operations for hepatic hydatid disease. In all cases D-TD involvement was confirmed by ultrasonography, CT, or MRI scan. We prop ose a new classification (grades 1-5) based on the degree of developme nt of D-TD involvement. Before 1984 exposure was obtained by thoracoph renolaparotomy (nine cases) and later by right subcostal incision. Onl y four patients required atypical pulmonary resection. In 13 cases the diaphragm was repaired, and all 21 hepatic cysts were treated with to tal (16 cases) or partial (8 cases) cystopericystectomy. There was no operative mortality, and the most serious morbidity consisted of a bil iary fistula and a biliobronchial fistula. For treatment of these pati ents we recommended right subcostal incision and total or near-total c ystopericystectomy as a first choice of surgical technique.