Presentation the new surgicaly approach in the treatment of pediatric lung hydatid disease non–captonage procedure without closure of the communication bronchial opening

Abstract

Introduction: Treatment of pediatric lung hydatid disease is primarily surgical, and any suspicion on hydatid lung disease justified indication for surgical intervention. The aim of our research is to investigate efficacy and safety of treatment of residual cavity by "non-capitonage" method, without closure of communicating bronchial opening compared to the classic "capitonage" method with closure of communicating bronchial opening. Patients and Methods: The study included 80 patients of both sexes under aged 18 years, who were surgically treated at the Clinic for Child Surgery and the Department of Thoracic Surgery, Clinical Center University in Sarajevo (KCUS) and Childrens Surgical Clinic of the Institute of Children's Diseases, Clinical Center of Montenegro in Podgorica due to pulmonary echinococcosis, based on clearly defined criteria for inclusion and exclusion from the study. 40 patients (group A) were subjected to non-capitonnage treatment of residual cavity that remained after the removal of parasites and partial pericystectomy without closure of orificium of bronchial opening. The control group consisted of 40 patients who had done narrowing of residual pericystic cavity with closure of bronchial opening. This is a multicenter, open-targeted clinical comparative study of safety of surgery procedures and intraoperative findings. Important aspects of these procedures being assessed included: the duration of the surgical procedure, the amount of administered blood products, drainage length, the amount of secretion, duration of drainage fistula, the time required for reexpansion of lungs, and variables of complications (such as : occurrence of empyema, atelectasis, postoperative fever, postoperative wound infection). Postoperative effectiveness (efficacy) was measured by a record of length of stay in the intensive care unit and hospital stay, as well as radiological findings of the subjects lungs six months after surgery. Results: In the control group we observed that the overall time of surgery was longer compared to the study group. Man-Vitni’s U test confirmed a statistically significant difference between the results of the test and control groups, U = 285.50, z = 4.957, p = 0.0001. Additionally, we observed a slightly larger amount of fluid drained in the control group vs. the study group. Man-Vitni’s U test revealed a statistically significant difference in the amount of drained fluid between the study and control groups, U = 325.50, z = 4.583, p = 0.0001. In the study group there were no cases of postoperative pulmonary atelectasis, while in the control group were 16 (40.0%) patients with documented atelectasis. Mean time to reexpansion of the lung using the control radiological findings was 11 days in the study group (Md = 11.000 days, n = 40) vs. 16 days in the control group of patients (MD = 16.000 days, n = 40) . We also observed that the control group of subjects had significantly longer time in the intensive care unit compared with the experimental group (U = 426.00, z = 3.654, p = 0.0003). Subjects in the control group had significantly longer hospitalizations compared with the experimental group (U = 373.50, z = 4.112, p = 0.0001) as well. Conclusions: We report here meaningful differences in two surgical approaches to the managamanet of hydatid disease in our medical system. Non-capitonnage surgical methods resulted in a significantly shorter duration of surgery, smaller drainage of secretions, atelectasis and pleural empyema events, shorter time required for reexpansion of the surgically intervened lungs and better overall outcomes, vs. the control surgical approach 6 months postoperatively. In our experience, non-capitonnage surgical methods compared much more favorably when compared to the capitonnage method, as reflected in the significantly shorter postoperative stay of patients in the intensive care unit and in hospital. The treatment of any residual pericystic cavity of pulmonary echinoccocus in children, especially if it is a giant, complicated and multiple hydatid cysts should be the method of "non-closure" or "no-narrowing" (non-capitonnage) due to the rapid overlaying of residual pericystic cavity by epithelial cells originating from surrounding pleura and lung parenchyma