Surgical management of pulmonary hydatid cysts in children in KwaZulu-Natal Province, South Africa

Abstract

Background. Pulmonary hydatid cyst disease is still a major problem in countries like South Africa (SA), where livestock farming is common. Hydatidosis has a variable clinical course depending on the size, location and complications of the cyst. For pulmonary cysts of any size, surgery remains the gold standard for treatment, with lung conservation surgery being the ideal.

Objectives. To describe the epidemiology, clinical presentation, surgical management, and surgical outcomes of paediatric pulmonary hydatid disease in children referred to the Department of Cardiothoracic Surgery at Inkosi Albert Luthuli Central Hospital (IALCH) in KwaZulu-Natal Province, SA.

Methods. We retrospectively reviewed and analysed the medical records of 38 children between the ages of 0 and 18 years with pulmonary hydatid cysts, who were referred to the Department of Cardiothoracic Surgery at IALCH and underwent surgical management between 1 January 2008 and 31 December 2018. The medical records were evaluated for patients’ demographics, clinical evaluation, surgical management strategies and surgical outcomes.

Results. Of the 38 patients, 60.5% were male, with a mean age of 6.5 years. More than two-thirds of the patients (68.4%) were from the Eastern Cape and 31.6% were from KwaZulu-Natal. The majority of the cysts (84.2%; n=32) were classified as large (5 - 9 cm in diameter) and giant (≥10 cm in diameter). Forty-eight surgical procedures were performed and lung preservation surgery by enucleation and capitonnage was preferred. Some patients developed postoperative complications such as prolonged air leaks from bronchopleural fistula (18.8%; n=9) and 88.9% (n=8) of these patients healed with chest tube drainage and physiotherapy. Lung resection was only required in 4% (n=2) of the patients. The mean (standard deviation) number of days spent in hospital was 7 (4) days. All children survived with no recurrences.

Conclusion. Conservative surgical procedures such as enucleation of the cysts of any size are possible, safe, reliable and reproducible