What is the meaning of capittonage in the treatment of hydatid cyst ?

It is a Surgical closure of a cyst cavity.





IN DETAIL IN THE TREATMENT OF HYDATED CYST








Diagnosis of pulmonary hydatid cysts is generally based on clinical and radiological findings. Pulmonary hydatid disease presents a wide range of radiological findings [5]. Uncomplicated cysts are seen as round opaque lesions on chest radiography. Infection and perforation may change the radiographic appearance of hydatid cyst, which may lead to an incorrect diagnosis and delayed treatment. Although infected cysts are usually associated with perforation, this is not generally true and some ruptured cysts may remain uninfected [6,7]. Computed tomography (CT) may be helpful in establishing the diagnosis in complicated cysts, but the routine use of CT is not recommended unless a complicated hydatid cyst is suspected. [8]. CT is also helpful to detect malignant lesions in elderly patients and a useful guide for surgeons, allowing to perform a single operation for bilateral pulmonary and concomitant liver cysts.





Although several clinical laboratory studies including, fiberoptic bronchoscopy, Casoni�s intradermal test, and the indirect hemaglutination test are believed to be useful in the diagnosis, these tests/interventions are not reliable for reported sensitivity rates vary significantly [9,10,11]. Therefore these tests are not used for diagnosis routinely. Although a recent report has suggested medical therapy with albendazole in patients with hydatid cyst disease [12], surgery continues to be the treatment of choice in pulmonary hydatid disease. Chemotherapy alone is not reliable in controlling this disease. Albendazole is used routinely only in the treatment of patients with thoracoabdominal multiple hydatid disease, those with complicated hydatid cysts of the lung, in patients that have undergone nonradical resection, in patients with recurrent cysts and in inoperable cystic hydatidosis.





Operation is the treatment of choice for pulmonary hydatid cysts. Various surgical procedures have been described in the literature, namely, excision of the entire cyst by enucleation (Barret technique), excision of pericyst (Perez Fontana), cystotomy, capitonnage, wedge resection, segmentectomy, and lobectomy [2,6]. The choice of surgical technique depends on the conditions encountered during surgery. As a rule, the lung parenchyma should be preserved as much as possible in patients with pulmonary hydatid disease and radical procedures must be avoided [13]. If, however, bronchiectasis or severe inflammation is present, the affected lung should be excised. Lung resection was carried out in 3 (3.2%) of our patients with infected cysts. In our series, we tried to avoid lung resection in treatment of the infected cyst as much as possible and we believe this policy has contributed to the successful outcome in our patients. For this reason, we have concluded that parenchyma resection should not be the first choice for the treatment of an infected hydatid cyst. Decortication was performed in 5 patients (5.4%), because of the pleural thickening. Conservative surgical techniques, such as cystotomy plus capitonnage constituted the routine surgical approach in our clinic. But, recently, we started to perform cystotomy plus closure of bronchial openings technique. While conservative surgical technique such as capitonnage is widely performed for the management of the residual cystic space, it can cause atelectasis by obliterating the bronchus surrounding the cyst or the residual cavity may not be obliterated completely by this procedure. Especially in patients with perforated cysts, postoperative complication rates can be lowered by the application of the cystotomy plus closure of bronchial openings technique.





About 20% of patients with lung hydatid cysts also have cysts in the liver. Pulmonary hydatid cyst patients with concomitant hepatic cysts are approached through a right thoracophrenotomy if the liver cysts is a) located on the upper surface of the liver, b) located in the upper and posterior part of the right lobe of the liver, c) penetrating through the diaphragm into the pleura, lung, or pericardium, and d) located in the upper part of the left lobe of the liver [14].





In conclusion, CT scans of the chest and upper abdomen are helpful for diagnosis and for selection of the appropriate surgical approach in patients with complicated hydatid cyst of the lung. Conservative surgical procedures should be used as first choice. The lung parenchyma should be preserved as much as possible. In patients with coexisting liver cysts, thoracotomy or median sternotomy accompanied by transdiaphragmatic approach is preferable. An appropriate surgical approach results in low complication and recurrence rates.

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