The surgical management of complicated pulmonary hydatid cysts

Iran is recognized as an endemic area for lung hydatidosis. Surgical removal of some hydatid cysts may have setious morbid consequences. To determine the characteristics of these special cysts, a retrospective survey was carried out on patients admitted to Modarres Hospital in Tehran between 1989 and 1998. We have found that ruptured, bilateral, lung located, and giant cysts (>] 0 cm) cause more surgical and anesthetic complications, thus we named them "complicated cysts". Of 110 patients, 62(56.4%) had complicated hydatid cysts. Of these, 2 individuals died during anesthesia induction because of hypoxemia. Since sudden severe hypoxemia did not respond to all essential measures, the patients were returned to the supine position (from lateral decubitus position), then rigid bronchoscopy was performed for drainage of cyst secretions and fragments of laminated membrane. At the time of induction of anesthesia, the contents of a ruptured cyst may spill into the airway and cause hypoxemia and even death. In order to prevent this complication, two different approaches were used: (l)A chest tube was introduced into the cyst through the chest wall and its contents were drained; (2) Patients were placed in the sitting position during intubation. Double lumen endotracheal tube (DLT) may allow salvage of unaffected lung from inadvertent leakage of cyst contents or laminated membrane emboli formation, but it does not guarantee a safe operation. Thus, rigid bronchoscopy should always be available. Cystostomy was the most common surgical technique performed in our center (80%). Massive air leakage, bronchial fistula, and permanent lobar collapse were the main indications for lung resection in our series. Surgical complication rates of our study were higher than reports from the west. Coordination and cooperation of experienced surgeons and anesthetists can result in better outcomes following complicated cyst removal.