ANZ J. Surg. 2004; 74 : 40–42 ORIGINAL ARTICLE ORIGINAL ARTICLE IS CAPITONNAGE UNNECESSARY IN THE SURGERY OF INTACT PULMONARY HYDATID CYST? M EHMET B ILGIN , F AHRI O GUZKAYA AND Y IGIT A KÇALI Department of Thoracic and Cardiovascular Surgery, Erciyes University Medical, Faculty, Kayseri, Turke Background: Hydatid disease, a parasitosis, is still an important health problem in Turkey. Surgery is the choice of tre pulmonary hydatid cyst. In this study, cystotomy and capitonnage were compared to cystotomy. Methods: Fifty-nine patients with 70 pulmonary intact hydatid cysts were surgically treated between 1993 and 1999. T females and 48 males (range 4–58 years). Cystotomy and closure of bronchial openings were performed in all patients were divided into two groups. In Group A ( n = 32 patients, n = 38 cysts), the cavity was closed (capitonnage), and in Group B ( n = 27 patients, n = 32 cysts) capitonnage was not performed. The patients treated by other surgical methods (pericystectomy, and others) were not included in this study. Results: Prolonged air leak (> 5 days) was found in one patient in Group A, and in four patients in Group B. Atelectasi oped in one patient in Group A, and in three patients in Group B. Additionally, in Group B pseudocystic appearance oc in two patients and empyema in one patient. The duration of hospitalization was 9.8 ± 2.1 days for Group A, and 12.4 ± 3.2 days for Group B. There was a significant difference between the groups for hospital time ( p < 0.01). There was no mortality in either group. Conclusion: This study shows that capitonnage is a procedure that should not be easily abandoned, despite the curren opinions, because of its low complication rate. Key words: capitonnage, cystotomy, hydatid disease. INTRODUCTION Surgery is the choice of treatment for most patients with pul- monary hydatid disease. The object of the surgery is the evacua- tion of the cyst and the removal of endocyst. Some papers have been published about the uselessness of obliteration of residual cavity (capitonnage) in the surgery of intact lung cysts. 1,2 In this present study, we compared the results of two different surgical techniques, that is, cystotomy with or without capitonnage for intact pulmonary hydatid cyst. MATERIALS AND METHODS The patients were randomized to each treatment, using sequential randomization technique. Thirty-five patients were included in the study for each group. Three patients who had capitonnage (Group A) did not attend follow-up visits and 32 patients were included in this study for this group. Eight patients without capi- tonnage (Group B) did not attend follow-up visits and 27 patients were included in the study for this group. Finally, a total of 59 patients were included in the study. Fifty-nine patients with 70 intact hydatid cysts, who had been surgically treated between 1993 and 1999, were studied. The study was designed as a pro- spective randomized study, and all operations were performed by the same surgical team. The number of the patients with hyd cyst during this period was 129, and 70 of them were the pa with intact hydatid cyst. There were six females, 26 ma Group A, and five females, 22 males in Group B. Their ranged from 4 to 47 years (mean 23 ± 14.8), and from 7 to 58 years (mean 27 ± 15.4) in Group A and B, respectively. The average age was not statistically significant between the gro ( P > 0.01). The number of the solitary cysts was 29 (90.6%) i Group A, and 25 (92.6%) in Group B. The most common loca of cysts was the right lower lobe (Table 1). The preope evaluation was carried out by means of physical examin chest roentgenogram, abdominal ultrasound, and comput tomography of the chest and upper abdomen. All patients underwent posterolateral thoracotomy (standa muscle-sparing). The wound and lung, apart from the area c taining the cyst, were covered with sponges moistened with saline solution to prevent the implantation of the scolic daughter cysts. As the lung was kept inflated, a 16-G needle nected to the suction tip, was inserted into the cyst. F needle aspiration, antiscolicidal agent (povidon iodin 10%) w injected into the cystic cavity. When the cyst was aspirated a its fluid evacuated as completely as possible, the most promi part of the cyst was opened (cystotomy) and the cyst membr was removed with ring forceps. The cavity was then irr with saline solution and the bronchial openings were sutured Group A, residual cavities by imbricating sutures (capitonna using 3–0 absorbable polybutylate suture material were obli ated (capitonnage). Capitonnage-time was recorded. In Grou bronchial openings were sutured without capitonnage. Patients who had beentreated by other surgical methods because of complicated cysts, and patients ( n = 8) with hepatic cyst hydatid who had been treated through phrenotomy excluded from the study. M. Bilgin MD; F. Oguzkaya MD; Y. Akçali MD. Correspondence: Mehmet Bilgin, Department of Thoracic Surgery, Erciyes University Medical School, 38039 Kayseri, Turkey. Email: bilginm@erciyes.edu.tr Accepted for publication 5 February 2003.