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Richter J, Lindner AK, Geisel D, Fleckenstein FN, Torsello GF, Millet Pascual-Leone B, Ivanov O, Zöllner C, Wilde ACB, Equihua Martinez G. Percutaneous drainage and combined praziquantel-albendazole therapy: a novel approach for the treatment of simple echinococcal liver cysts. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:500-507. [PMID: 37729942 DOI: 10.1055/a-2084-3735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Cystic echinococcosis (CE) is a worldwide helminthic zoonosis causing serious disease in humans. The WHO Informal Working Group on Echinococcosis recommends a stage-specific treatment approach of hepatic CE that facilitates the decision on what therapy option is most appropriate. Percutaneous aspiration, instillation of a scolicide, e.g., ethanol or hypertonic saline, and subsequent re-aspiration (PAIR) have been advocated for treating medium-size unilocular WHO-stage CE1 cysts. PAIR can pose a risk of toxic cholangitis because of spillage of ethanol in the case of a cysto-biliary fistula or of life-threatening hypernatriaemia when hypertonic saline is used. The purpose of our study is to develop an alternative, safe, minimally invasive method to treat CE1 cysts, avoiding the use of toxic topic scolicides.We opt for percutaneous drainage (PD) in four patients: the intrahepatic drainage catheter is placed under CT-fluoroscopy, intracystic fluid is aspirated, and the viability of intracystic echinococcal protoscolices is assessed microscopically. Oral praziquantel (PZQ) is added to albendazole (ABZ) instead of using topical scolicidals.Protoscolices degenerate within 5 to 10 days after PZQ co-medication at a cumulative dosage of 250 to 335 mg/kg, and the cysts collapse. The cysts degenerate, and no sign of spillage nor relapse is observed in the follow-up time of up to 24 months post-intervention.In conclusion, PD combined with oral PZQ under ABZ coverage is preferable to PAIR in patients with unilocular echinococcal cysts.
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Affiliation(s)
- Joachim Richter
- Institute of International Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas K Lindner
- Institute of International Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Olga Ivanov
- Institute of International Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Caroline Zöllner
- Department of Gastroenterology and Hepatology, Charité Universitätsmedizin Berlin, Berlin, Germany
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2
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Aydın Y, Kasalı K, Ulaş AB, Dostbil A, İnce İ, Eroglu A. Comparing Capitonnage and Uncapitonnage Techniques for Pulmonary Hydatid Cysts: A Systematic Review and Meta-analysis. Eurasian J Med 2023; 55:35-42. [PMID: 37916996 DOI: 10.5152/eurasianjmed.2023.22281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Surgery is the primary treatment for pulmonary hydatid cysts. This systematic review and meta-analysis aimed to compare the results of capitonnage and uncapitonnage techniques for the surgery of pulmonary hydatid cysts. Descriptive Boolean queries were used to search PubMed, Scopus, and Web of Science for articles published up to June 2022 to evaluate the outcomes of pulmonary hydatid cysts in terms of mortality, postoperative complications, and hospital stay. A total of 12 studies were included. An analysis of the total side effects revealed that there was a statistically significant difference between the capitonnage and uncapitonnage groups (odds ratio=3.81, 95% confidence interval=[1.75-8.31], P < .001). The results showed that more side effects were observed in the uncapitonnage group than in the capitonnage group. The risk of side effects in the uncapitonnage group is 3.81 times higher than in the capitonnage group. The results showed that more prolonged air leak was seen in uncapitonnage group than in the capitonnage group (odds ratio=4.18, 95% confidence interval=[1.64-10.64], P=.003). The results show that more empyema was observed in uncapitonnage group than in the capitonnage group (odds ratio=4.76, 95% confidence interval=[1.29-17.57], P =0.020). An analysis of atelectasis and mean hospital stay revealed that there was no statistically significant difference between the capitonnage and uncapitonnage groups. The results reveal the advantages of capitonnage in the treatment of pulmonary hydatid cysts and that the capitonnage method is quite effective in reducing complications compared to the uncapitonnage method.
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Affiliation(s)
- Yener Aydın
- Department of Thoracic Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Kamber Kasalı
- Department of Anesthesiology, Atatürk University Medical Faculty, Erzurum, Turkey; Department of Biostatistics, Atatürk University Medical Faculty, Erzurum, Turkey
| | - Ali Bilal Ulaş
- Department of Thoracic Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Ayşenur Dostbil
- Department of Anesthesiology, Atatürk University Medical Faculty, Erzurum, Turkey;Department of Anesthesiology and Reanimation, Atatürk University Medical Faculty, Erzurum, Turkey
| | - İlker İnce
- Department of Anesthesiology and Reanimation, Atatürk University Medical Faculty, Erzurum, Turkey
| | - Atilla Eroglu
- Department of Thoracic Surgery, Atatürk University School of Medicine, Erzurum, Turkey
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Cai B, Li C, Luo Z, Ciren D, Guo W, Huang J, Dawa Q. Efficacy and safety of video-assisted thoracoscopic surgery and thoracotomy in the treatment of pulmonary hydatid disease in the Tibetan Plateau: a retrospective study. J Thorac Dis 2022; 14:2247-2253. [PMID: 35813763 PMCID: PMC9264056 DOI: 10.21037/jtd-22-714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
Background Although video-assisted thoracoscopic surgery (VATS) plays an increasingly significant part in treating thoracic disease, the role of thoracotomy is not replaced in cystic echinococcosis. The aim of this study was to demonstrate the application of VATS and traditional thoracotomy in the treatment of pulmonary hydatid disease in Shigatse of the Tibet Plateau and to compare the clinical safety and efficacy of these two surgical approaches. Methods A total of 53 patients with pulmonary hydatid who received thoracoscopic cystectomy with needle aspiration from January 2015 to December 2020 were enrolled in the study, and 126 patients who received thoracotomy during the same period were matched as the control group. The clinical characteristics, operative time, incidence of perioperative complications, length of stay, and hospitalization cost of the VATS and thoracotomy groups were analyzed to compare the safety and efficacy. Patients were followed up through telephone and outpatient service. In order to balance potential confounding baseline factors, propensity-score matching (PSM) was applied to establish a 1:1 VATS to thoracotomy group ratio. Results There were statistically significant differences between the VATS group and the thoracotomy group in operative time, blood loss, drainage volume, and postoperative hospital stay (P<0.05), with the VATS group being superior to the thoracotomy group. There were no significant differences in postoperative complications, adverse imaging outcomes, or recurrence rates between the 2 groups. In terms of complications, there was no significant difference in the incidence of postoperative air leakage, atelectasis, or other common complications between the 2 groups, while the frequency of postoperative fever and incision infection in the thoracotomy group was significantly higher than that in the VATS group (P<0.05). Moreover, the postoperative recurrence rate between the 2 groups showed no significant difference after a 3-year follow-up. Conclusions Compared to traditional thoracotomy, VATS had acceptable efficacy and safety and it could further accelerate postoperative recovery and reduce the cost in the treatment of pulmonary hydatid disease in the Tibetan Plateau. Thus, VATS should be promoted more widely to other Tibetan regions.
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Affiliation(s)
- Benjie Cai
- Department of Thoracic Urological Surgery, Shigatse People's Hospital, Shigatse, China
| | - Chao Li
- Department of Thoracic Urological Surgery, Shigatse People's Hospital, Shigatse, China
| | - Zhui Luo
- Department of Thoracic Urological Surgery, Shigatse People's Hospital, Shigatse, China
| | - Dunzhu Ciren
- Department of Thoracic Urological Surgery, Shigatse People's Hospital, Shigatse, China
| | - Weigang Guo
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jia Huang
- Department of Thoracic Urological Surgery, Shigatse People's Hospital, Shigatse, China.,Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qingda Dawa
- Department of Thoracic Urological Surgery, Shigatse People's Hospital, Shigatse, China
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Aydin Y, Ulas AB, Ince I, Kuran E, Keskin H, Kirimli SN, Kasali K, Ogul H, Eroglu A. Modified capitonnage technique for giant pulmonary hydatid cyst surgery. Interact Cardiovasc Thorac Surg 2021; 33:721-726. [PMID: 34041544 DOI: 10.1093/icvts/ivab152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study investigated the effectiveness of the modified technique (Aydin Technique), which was applied for capitonnage in the surgical treatment of giant pulmonary hydatid cysts. METHODS Twenty-two cases were operated on for giant hydatid cysts with a total of 23 modified techniques for capitonnage (bilateral giant hydatid cyst in 1 case) in our clinic between January 2018 and December 2020. The demographic data were recorded. RESULTS Thirteen out of 22 (59.1%) of cases were male and 9 (40.9%) were female. The mean age was 22.0 ± 15.8 and 14 cases (63.6%) were children. Hydatid cysts were intact in 13 (56.5%) cases and ruptured in 10 (43.5%) cases. Hydatid cyst diameters were on average 123 ± 21 mm. A modified method was performed for capitonnage in all cases while decortication was performed in 2 (8.7%) cases due to pleural thickening. Radiological atelectasis was observed in 6 cases (27.3%) postoperatively. The patients with atelectasis recovered without any clinical problem and no intervention was needed. In 1 case, an infection developed at the incision site. Postoperative prolonged air leak, empyema and mortality were not observed in any of the cases. The postoperative mean length of hospital stay was 7.18 ± 2.15 days. The mean follow-up period was 19.5 ± 11.5 months. No recurrence was encountered in the follow-up of the patients. CONCLUSIONS The results of this study may suggest to perform this new-described modified Aydin technique to avoid major capitonnage complications of the giant pulmonary hydatid cyst surgery.
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Affiliation(s)
- Yener Aydin
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey.,Anesthesiology, Clinical Research Office, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Ali Bilal Ulas
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Ilker Ince
- Anesthesiology, Clinical Research Office, Ataturk University, School of Medicine, Erzurum, Turkey.,Department of Anesthesiology and Reanimation, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Emre Kuran
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Hilmi Keskin
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Sevde Nur Kirimli
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Kamber Kasali
- Anesthesiology, Clinical Research Office, Ataturk University, School of Medicine, Erzurum, Turkey.,Department of Biostatistics, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Hayri Ogul
- Anesthesiology, Clinical Research Office, Ataturk University, School of Medicine, Erzurum, Turkey.,Department of Radiology, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Atilla Eroglu
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey
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Richter J, Lindner AK, Geisel D, Torsello GF, Martinez GE, Isner C, Schürmann D, Pfäfflin F, Orhun A, Manciulli T, Brunetti E. Treatment of a giant hepatic echinococcal cyst with percutaneous drainage and in vivo assessment of the protoscolicidal effect of praziquantel. Clin J Gastroenterol 2021; 14:888-892. [PMID: 33851365 PMCID: PMC8154811 DOI: 10.1007/s12328-021-01397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
Therapy choices for cystic echinococcisis (CE) are stage-specific: surgical, minimally invasive, medical or observation without intervention. PAIR (percutaneous aspiration, instillation of a scolicide, and re-aspiration) has been considered the treatment of choice for uncomplicated echinococcal liver cysts. However, PAIR carries the risk of toxic cholangitis or hypernatremia and that the cyst frequently refills with bile after withdrawing the catheter. We treated a patient with a giant CE 1 liver cyst with puncture drainage (PD) under albendazole coverage. Drainage enabled us to monitor the morphology of protoscolices under praziquantel (PZQ) co-medication. Protoscolices degenerated within 5 days of PZQ 50 mg/kg/d. The cyst cavity solidified with no evidence of reactivation or secondary spread. Percutaneous treatments can replace surgery in a significant number or cases with hepatic CE. PD allows to assess microscopically the viability of protoscolices under co-medication with PZQ-albendazole and to avoid the instillation of topical scolicides.
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Affiliation(s)
- Joachim Richter
- Institute of Tropical Medicine and International Health, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Augustenburgerplatz 1, 13353, Berlin, FR, Germany.
| | - Andreas Karl Lindner
- Institute of Tropical Medicine and International Health, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Augustenburgerplatz 1, 13353, Berlin, FR, Germany
| | - Dominik Geisel
- Department of Radiology, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Giovanni Federico Torsello
- Department of Radiology, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Gabriela Equihua Martinez
- Institute of Tropical Medicine and International Health, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Augustenburgerplatz 1, 13353, Berlin, FR, Germany
| | - Caroline Isner
- Department of Infectious Diseases and Pulmonary Medicine, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Dirk Schürmann
- Department of Infectious Diseases and Pulmonary Medicine, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Frieder Pfäfflin
- Department of Infectious Diseases and Pulmonary Medicine, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Arzu Orhun
- Department of Plastical and Reconstructive Surgery, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Tommaso Manciulli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University Hospital of Pavia, Pavia, Italy
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University Hospital of Pavia, Pavia, Italy
- Department of Tropical and Infectious Diseases, IRCCS Policlinico San Matteo Foundation Hospital, Pavia, Italy
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6
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Lupia T, Corcione S, Guerrera F, Costardi L, Ruffini E, Pinna SM, Rosa FGD. Pulmonary Echinococcosis or Lung Hydatidosis: A Narrative Review. Surg Infect (Larchmt) 2020; 22:485-495. [PMID: 33297827 DOI: 10.1089/sur.2020.197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lung hydatidosis is a zoonosis related to infection by the Echinococcus tapeworm species. Lung involvement in this condition is second only to the liver echinococcosis. Diagnosis ordinarily results from an accidental finding in a direct chest radiograph evaluation because of the delayed growth of the cysts. Moreover, a consistent treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. In this review, we expect to sum up the main features of lung hydatidosis with a perspective on medical and surgical treatment. Methods: Cochrane Library and PubMed were the databases used to perform a narrative literature review. Search terms included "pulmonary echinococcosis" and "lung hydatidosis." The MeSH terms were "lung" [All Fields] AND {"echinococcosis" [MeSH Terms] OR ("hydatidosis" [All Fields] OR "pulmonary" [All Fields] AND "echinococcosis" [All Fields] OR "hydatidosis." A search period from September 1980 to May 2020 was chosen to compare studies from different decades, given the changes in pulmonary echinococcosis management. Results: A uniform treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. No clinical trials have analyzed and compared all the diverse treatment approaches. Cyst size, characteristics, position in the lung and clinical presentation, and the availability of medical/surgical expertise and equipment are the mainstays of echinococcosis management. When feasible, surgery is as yet the principal therapeutic choice to eliminate the cysts; anti-parasitic drugs may minimize complications during high-risk surgery or be used as definitive therapy in some instances with contraindications to surgery. Conclusions: Lung hydatidosis management must become less heterogeneous. We support treatment directed to the subject established on the clinical scenario, host factors, and surgical risk. Strict cooperation in this process between infectious disease specialists and surgeons may optimize best practices to help create shared practical guidelines to simplify clinicians' decision-making. Furthermore, we need a consensus for lung hydatidosis treatment and inserting this disease to global surgery agenda will have a positive impact on acquiring high-quality data that enables us to create an evidence-based guideline for this disease.
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Affiliation(s)
- Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Francesco Guerrera
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Lorena Costardi
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Enrico Ruffini
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Francesco G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
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Surgical management of pulmonary hydatid cysts in children in KwaZulu-Natal Province, South Africa. Afr J Thorac Crit Care Med 2020; 26. [PMID: 34240027 PMCID: PMC8203051 DOI: 10.7196/ajtccm.2020.v26i3.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 02/06/2023] Open
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.
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