Sir,
We read with great interest the article of Sindhwani et al [1] in which the authors report a case of a patient with mediastinal hydatid cyst successfully treated by percutaneous aspiration followed by Albendazole therapy. In the light of their experience, the authors conclude that percutaneous aspiration may be a safe option in managing of mediastinal and pulmonary hydatid cyst in agreement with our experience [2].
However, in our paper we clarify that surgical intervention is still the main modality for the treatment of hydatid disease especially in presence of giant cyst (> 10 cm) [3]. Thus, we present a novel technique that allows the aspiration of a cyst during surgical resection of hydatid cyst in order to reduce the risk of anaphylaxis and dissemination of disease due to enucleation or simple needle aspiration. This is a homemade double suction device designed to aspirate hydatid cysts by creating a low pressure, wide mouth cylinder which holds the cyst wall against the base of the cylinder. A large thoracentesis needle is inserted across the low pressure chamber into the cyst to aspirate the fluid within. The complete evacuation of the cyst makes surgical treatment easier and facilitates its successive removal.
Thus, the home device reported above is designed for surgical treatment of hydatid cyst via thoracotomy, but a homemade device for percutaneous aspiration is not yet born!
However, we hope in the future to adapt such a device in order to validate its practice in percutaneous aspiration of hydatid cyst as supposed by Sindhwani et al [1]. It might make percutaneous aspiration of hydatid cysts easier and safer permitting the complete evacuation of hydatid cysts without any spillage.
REFERENCES
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Sindhwani G, Dua R, Rawat J, et al. Aspiration of mediastinal hydatid cyst: a case report. Internet J Med Update. 2009 Jul;4(2):42-4.
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Santini M, Fiorello A, Vicidomini G, et al. A home-made device for safe intraoperative aspiration of pulmonary hydatid cyst. Interact Cardiovasc Thorac Surg. 2008 May;7(3):365-7.
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Kosar A, Orki A, Haciibrahimoglu G, et al. Effect of capitonnage and cystotomy on outcome of childhood pulmonary hydatid cysts. J Thorac Cardiovasc Surg. 2006 Sep;132(3):560-4.
Prof. Mario Santini
Chirurgia Toracica - Seconda Università di Napoli,
Piazza Miraglia, 2, I-80138 Naples, Italy
Phone: +390815665228; Fax: +390815665230
Email: mario.santini@unina2.it