SURGICAL-TREATMENT OF ECHINOCOCCOSIS BY A TRANSTHORACIC APPROACH - A REVIEW OF 85 CASES

Objective: Human echinococcosis remains a serious health problem for t he Mediterranean countries, among them Greece. As there is no effectiv e medical therapy, surgery is still the treatment of choice. Material and methods: We present our experience in the surgical management of h ydatidosis by a transthoracic approach, based on 85 patients (49 male, 36 female, aged 4-86 years) treated during 1986-1996. Results: Twenty -one patients (26.3%) appeared with complications as: hydatidemesis (n = 5), hydropneumothorax (n = 3), cyst infection (n = 3), empyema thor acis (n = 8), cholebronchial (n = 3) and cholebronchopleural fistula ( n = 1). The location of the cysts was: 61 in the lungs (right, 29; lef t, 24; bilateral, eight), 31 on the liver dome, six in the pleural cav ity, two in the mediastinum, and one in each of pericardium, chest wal l, and right pararenal space. Surgical approach involved a thoracotomy or median sternotomy in all cases. Pulmonary endocystectomy and capit onnage was the procedure of choice in the surgical management. Hepatic cysts were approached through a right thoracophrenotomy and were mana ged with evacuation of the main and daughter cysts, suture of the diap hragm to the margins of the cyst, and drainage of the cystic and pleur al cavities. There was no in-hospital mortality. Major postoperative c omplications were: empyema thoracis (n = 3), biliary fistula (n = 2), and bronchopleural fistula (n = 1). Five patients presented later with seven recurrences of the disease. Conclusion: Transthoracic approach is a good and safe choice in surgical treatment of both the intrathora cic and the (concomitant or not) hydatid cysts on the upper surface of the liver. (C) 1998 Elsevier Science B.V. All rights reserved.