A novel closed book parenchyma sparing technique for giant pulmonary hydatid cysts

Abstract

BACKGROUND: Giant pulmonary hydatid cysts (GHCs), defined as cysts measuring ≥10 cm, pose significant surgical challenges owing to their large size and distortion of the native lung architecture, which often limits the effectiveness of conventional capitonnage. This study evaluates the feasibility and early clinical outcomes of a novel closed-book parenchyma-sparing technique designed to achieve complete residual cavity obliteration while preserving functional lung parenchyma. METHODS: A retrospective analysis was performed on 12 consecutive patients with GHCs who underwent surgery between September 2022 and August 2025. Diagnosis was confirmed by contrast-enhanced computed tomography. The closed-book technique involved controlled cyst evacuation, meticulous bronchial closure, and symmetrical bidirectional intracystic plication. Patients were followed for 15 months to assess postoperative complications, lung re-expansion, and recurrence. RESULTS: The mean patient age was 33.4 years, with female predominance (75%). Cyst size ranged from 11-16 cm (mean 13.5 cm), most commonly involving the right lower lobe and left upper lobe. Four patients presented with ruptured cysts. The technique achieved complete lung re-expansion in all cases. No postoperative air leaks, empyema, atelectasis, surgical site infection, residual cavity, recurrence, or mortality were observed during the 15-month follow-up. One patient developed a transient pleural effusion that resolved spontaneously. The mean hospital stay was 12.9 days. CONCLUSION: The closed-book parenchyma-sparing technique is a feasible and promising lung-preserving approach for GHCs. Larger prospective comparative studies are warranted to validate its safety, reproducibility, and long-term effectiveness.