Treatment of hydatid bilio-bronchial and bilio-pleuro-bronchial fistulas via thoracotomy.

Study aim: The aim of this study was to report the results of surgical treatment of hydatid bilio-bronchial et biliopleuro-bronchial fistulas via thoracotomy. Material and methods: From 1990 to 1998, 63 cases were observed in the same center. Biliptysis was the main symptom in 72% of cases. The diagnosis was based on chest radiography and abdominal ultrasonography; both examinations visualised the cyst, intrathoracic collections, a diaphragmatic breach and biliary lesions. All patients were treated by one-stage thoracotomy The procedures consisted of lung resection (lobectomy and/or segmentectomy) (n=47) and decortication (n=16) in the chest, cyst dome resection (n=61) or partial pericystectomy (n=12) in the abdomen and suture of the diaphragmatic defect in all cases after hepato-diaphragmatic deconnection. An additional laparotomy was necessary in 4 cases. Results: There were 8 deaths (12.7%): one intraoperative death due to haemorrhage and seven postoperative deaths, mostly related to pulmonary complications. Postoperative complications (14.3%) were mainly respiratory. Clinical and radiological results were good with a one-year follow-up. Conclusion: Bilio-bronchial and bilio-pleurobronchial fistulas due to hydatid cyst are rare, but severe diseases. They are responsible for lesions at three levels: abdominal, diaphragmatic and thoracic. A high perioperative mortality rate was observed. Thoracotomy is the best approach for surgical treatment at all three levels. (C) 2000 Editions scientifiques et medicales Elsevier SAS.