[Treatment of hydatid bilio-bronchial and bilio-pleuro-bronchial fistulas by thoracotomy].
OBJECTIVE
The aim of this study was to report the results of surgical treatment of hydatid bilio-bronchial et bilio-pleuro-bronchial fistulas via thoracotomy.


METHODS
From 1990 to 1998, 63 cases were observed in the same center. Biliptysis was the main symptom in 72% of cases. The diagnosis was based on chest radiography and abdominal ultrasonography; both examinations visualised the cyst, intrathoracic collections, a diaphragmatic breach and biliary lesions. All patients were treated by one-stage thoracotomy. The procedures consisted of lung resection (lobectomy and/or segmentectomy) (n = 47) and decortication (n = 16) in the chest, cyst dome resection (n = 61) or partial pericystectomy (n = 12) in the abdomen and suture of the diaphragmatic defect in all cases after hepato-diaphragmatic disconnection. An additional laparotomy was necessary in 4 cases.


RESULTS
There were 8 deaths (12.7%): one intraoperative death due to haemorrhage and seven postoperative deaths, mostly related to pulmonary complications. Postoperative complications (14.3%) were mainly respiratory. Clinical and radiological results were good with a one-year follow-up.


CONCLUSIONS
Bilio-bronchial and bilio-pleurobronchial fistulas due to hydatid cyst are rare, but severe diseases. They are responsible for lesions at three levels: abdominal, diaphragmatic and thoracic. A high perioperative mortality rate was observed. Thoracotomy is the best approach for surgical treatment at all three levels.
Kabiri
H
H
Service de chirurgie thoracique, CHU Ibn Sina, Rabat, Maroc.
Chafik
A
A
al Aziz
S
S
el Maslout
A
A
Benosman
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001658:Biliary Fistula / Q000473:pathology / Q000601:surgery*; D001983:Bronchial Fistula / Q000473:pathology / Q000601:surgery*; D002648:Child; D004443:Echinococcosis / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome