Comparative evaluation of thoracoscopy versus thoracotomy in the management of lung hydatid disease.
BACKGROUND
Lung hydatid disease is an endemic problem in Mediterranean countries, and the ideal surgical management for it is still debated. In this prospective study, we aimed to evaluate the feasibility and safety of thoracoscopy in patients with lung hydatid disease. We studied the advantages of thoracoscopic procedure over posterolateral thoracotomy.


METHODS
A total of 32 patients with an uncomplicated, unilateral lung hydatid cyst were subjected to surgical treatment over a period of 5 years. Of the 32 patients, 18 were treated with thoracotomy and 14 with thoracoscopy. Observations were made with regard to duration and ease of operation, complications, hospital stay, return to activity, and recurrence.


RESULTS
The mean operative duration in the thoracoscopy group was 95.21 min compared to 137.77 min in thoracotomy group (P < 0.0001). Postoperative analgesia requirement was less in the thoracoscopic group (mean 4.92 days) compared to that in the thoracotomy group (mean 13.94 days; P < 0.0001). The intercostal drain was removed earlier in the thoracoscopic group (mean 5 days) than in the thoracotomy group (mean 8.83 days; P < 0.0001). The postoperative hospital stay was 8.35 days (mean) in thoracoscopic group and 18.77 days in the thoracotomy group (P < 0.0001). The most serious morbidity was wound infection, with three cases (16.66%) in the thoracotomy group and one (7.11%) in the thoracoscopy group. There was no operative mortality and no recurrence during the follow-up period.


CONCLUSIONS
We strongly recommend the use of thoracoscopy as a primary tool for the management of uncomplicated, unilateral lung hydatid disease. Thoracoscopy offers a great advantage over open thoracotomy in terms of very low morbidity.
Mehta
Ketan D
KD
Department of Surgery, M. P. Shah Medical College, Jamnagar, Gujarat, 361008, India. drkdms@gmail.com
Gundappa
Rashmi
R
Contractor
Rajiv
R
Sangani
Viral
V
Pathak
Ashit
A
Chawda
Priti
P
D000328:Adult; D016009:Chi-Square Distribution; D004445:Echinococcosis, Pulmonary / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D013906:Thoracoscopy; D013908:Thoracotomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome