What Is the Best Surgical Approach for Bilateral Pulmonary Hydatid Cysts in Children?

Introduction: The most common site for hydatid cysts in children is the lungs while in adult hepatic cysts are predominant. Bilateral pulmonary involvement is relatively rare and its surgical management is poorly described in the current literature. Until now no definite consensus has been described in the literature for the ideal surgical approach in pediatric bilateral pulmonary hydatid cysts (BPHC). The aim of this prospective cohort study was to describe the problems encountered in treating pediatric BPHC by two different surgical techniques. Patients and Methods: Between June 2007 and June 2014, 60 children (group one = 31, group two = 29) with BPHC were operated on in our center. Group one included all children with BPHC operated by single session bilateral anterolateral mini-thoracotomy. Group two included all cases operated by two stage standard posterolateral thoracotomy at 21 days interval. Results: In group one (19 males and 12 females), the mean age was 8.9 years (3.5 17). In group two, there were 29 cases (18 males and 11 females), the mean age was 9.6 years (2 17). There was no significant statistical difference in terms of the presentations and age distribution. The duration of surgery in group one was significantly shorter and the duration of hospital stay was significantly shorter as well (group one 3.6 days versus 4.6 days in the second group). Pain scale was not more in the first group as it was believed to be. Conclusion: We believe that single session bilateral anterolateral thoracotomy is a better approach than either one stage successive thoracotomies, median sternotomy or clamshell thoracotomy as it involves less postoperative pain and does not precipitate a decrease in the respiratory capacity.