One stage surgical management of hydatid cyst of lung & liver- by right thoracotomy & phrenotomy Bhabatosh Biswas, M.Ch., Dipayan Ghosh, MBBS, Rupak Bhattacharjee, MBBS, Ashis Patra, DA, Subir Basuthakur, MD, Rajarshi Basu, MS Vivekananda Institute of Medical Sciences, Calcutta Medical Research Institute, Kolkata Abstract Introduction: Hydatid cysts of the lung are quite frequent in our country. Some patients have additional cysts in the liver. Though most of the liver cysts remain asymptomatic for long time, but may be symptomatic with increasing size. Surgical removal is the treatment of choice for both lung & liver cysts. Aim of the study was to establish suitability of one stage surgery for pulmonary & hepatic hydatid cysts. Methods: From 1996 through 2003 we operated on 216 pulmonary hydatid cysts, out of which 42 patients had hydatid cysts in the right lung as well as in the right lobe of liver. Right thoracotomy was done to remove the lung hydatids followed by phrenotomy to remove the liver cysts. Results: Right thoracotomy was done in 42 patients having hydatid cysts of lung & liver. In 36 patients, cysts were removed, bronchial leaks were sutured & residual cavities were obliterated. Out of rest 6 patients, having dense adhesions or destruction of pulmonary parenchyma, 4 had segmentectomy & 2 had lobectomy. Right phrenotomy was then done with radial incision above the palpated liver cysts. Hydatid cyst was removed from liver. Cavity and remaining pericystic liver tissue was inverted with sutures. Water seal chest drain & subdiaphragmatic drain were placed. Post operative albendazole was continued for 3 months in the dose of 10-20 mg/kg with a gap of 2 weeks after each month. Post operative recovery was uneventful in most of the cases. However, air leak continued for almost 3 weeks in 4 patients & 3 months in one patient. There was no death. Conclusion: Surgical management of pulmonary and hepatic hydatids with one stage right thoracotomy & phrenotomy is a suitable option. It avoids additional laparotomy and thereby additional cost & hospital stay. Results are quite satisfactory. (Ind J Thorac Cardiovasc Surg, 2004; 20: 88-90) Key words : Hydatid Cyst, Thoracotomy, Phrenotomy. Introduction Hydatid cysts are caused by the parasite "Echinococcus Granulosus', Hydatid disease is prevalent and wide spread in most sheep-rearing countries in Asia, Australia, South America and Southern Europe 1. These cysts are characterised by cystic space occupying lesions in the liver, the lungs and rarely in other parts of the body 23. Address for correspondence: Dr. Bhabatosh Biswas Uttara Housing, Flat-7C, 13, Broad Street, Kolkata 700 019, West Bengal Phone: (033) 2280 2624/6351, Mobile: 98310 21617 Email: bhabatos@cal2, vsnl.net.in @IJTCVS 097091342020604/65 Received - 14/3/04; Review Completed - 6/4/04; Accepted - 8/4/04. The liver acts as the first filter and the lungs as 2nd filter for the hydatid larvae. A considerable number of patients with lung hydatid cysts also have liver cysts. Most of the liver hydatids remain asymptomatic for a long time. With increasing size they may manifest with abdominal mass, discomfort and pain 45. Abdominal ultrasound is very useful for their diagnosis4-L Lung hydatids may also remain asymptomatic for long time and detected in incidental chest X-ray. Other lung hydatids may present with complications like lung abscess, empyema, bronchopleural fistula, bronchiectasis or atelectasis 2. Surgical removal is the treatment of choice for lung and liver hydatidsL Liver cysts located subphrenically should be treated simultaneously with the lung hydatids through right thoracotomy and phrenotomy to avoid a second operation 7. 065-04.p65 88 6/4./2004, 3:08 PM