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    Hydatid cysts of the lung: lesion size in relation to clinical presentation and therapeutic approach
    (Springer, 2014) Kuzucu, Akin; Ulutas, Hakki; Celik, M. Reha; Yekeler, Erdal
    The aim of this study was to assess the relationship between the pulmonary hydatid cyst size and the clinical presentation, surgical approach, and postoperative outcome. We review the problems encountered in treating large pulmonary hydatid cysts and highlight the risks associated with the rupture of the cyst and a delay of the surgical treatment. The medical records of 169 patients surgically treated for lung hydatid cysts were reviewed. Patients were divided into two groups based on cyst size: group 1 (n = 128) with small (< 10 cm) cysts and group 2 (n = 41) with giant (a parts per thousand yen10 cm) cysts. Data related to symptoms, preoperative complications, surgical procedures performed and postoperative morbidity were analyzed and compared. In both groups, the most common symptom was chest pain, followed by dyspnea and cough, respectively. There were no differences between the two groups with respect to cyst-associated parenchymal or pleural complications before surgery (p = 0.80). In the large majority of cases, the surgical treatment was cystotomy, removal of the cystic membrane and capitonnage. Wedge resection was performed in nine patients in total (seven in group 1, two in group 2) and one patient in group 2 required a lobectomy. Decortication was required significantly more frequently in group 2 than in group 1 (p = 0.001). Sixteen patients in group 1 and 10 patients in group 2 developed postoperative complications (p = 0.19). There was no peri or postoperative mortality. There was no difference between the groups with respect to the duration of hospitalization (p = 0.17). Two patients with complicated hydatid cysts in group 1 had recurrent lesions during follow-up, whereas there was no recurrence in group 2. All pulmonary hydatid cysts should be surgically treated as soon as possible after their diagnosis in order to avoid complications. Most of these lesions, regardless of size, can be surgically managed with procedures that preserve the maximal lung parenchyma and yield excellent outcomes.
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    Surgical management of upper- and lower-lobe bronchiectasis without middle lobe involvement: is middle lobectomy necessary?
    (W B Saunders Co-Elsevier Inc, 2012) Ulutas, Hakki; Celik, M. Reha; Kuzucu, Akin
    Postoperative quality of life is a crucial factor in decisions regarding surgical management of bronchiectasis. The goal of surgical treatment in such cases is to eradicate diseased portions of lung while preserving as much healthy lung parenchyma as possible. The volume of remaining lung must be sufficient to fill the pleural space. In patients with bronchiectasis, it is extremely unusual to have upper- and lower-lobe involvement without middle lobe involvement. A normal-sized middle lobe alone is usually not adequate to fill the right hemithorax. When the disease involves both the upper and lower lung lobes, surgeons must assess whether pneumonectomy is required. Herein, we describe the case of a patient with bronchiectasis who was successfully treated with upper and lower lobectomy and preservation of the middle lobe. (C) 2012 Elsevier Inc. All rights reserved.