Comparison of Clinical Outcomes of Cystotomy and Bronchial Fistula Closure With or Without Capitonnage in the Treatment of Pulmonary Hydatid Cysts



Vahedi M ; Amini H ; Rezaei M ; Neishaboury M ; Samimiat A
Source: Tehran University Medical Journal Published:2026

Abstract

Background: Pulmonary hydatid cyst is a common manifestation of cystic echinococcosis in endemic regions, and surgery remains the mainstay of treatment. In conservative surgical management, closure of bronchial fistulas after cystotomy and cyst evacuation is essential; however, the role of capitonnage in managing the residual cavity remains controversial. This study aimed to compare the outcomes of cystotomy and bronchial fistula closure with and without capitonnage in patients with pulmonary hydatid cysts. Methods: This prospective cohort study included 26 patients with confirmed pulmonary hydatid cysts who underwent surgery at Sina and Imam Khomeini hospitals between 2023 and 2025. Patients were equally divided into two groups: cystotomy with bronchial fistula closure and capitonnage (n=13) and cystotomy with bronchial fistula closure without capitonnage (n=13). Demographic data, comorbidities, lesion characteristics, and postoperative outcomes, including hospital stay, chest tube duration, air leak, empyema, pleural effusion, and hemoptysis, were recorded and analyzed. Results: Baseline characteristics were comparable between the groups. The mean age was 29.2±12.8 years in the capitonnage group and 30.5±13.4 years in the non-capitonnage group, and 62% of patients in both groups were male. Hospital stay was significantly shorter in the capitonnage group than in the non-capitonnage group (5.9±1.8 vs. 8.5±2.4 days; P=0.03). Chest tube duration was also reduced (64.2±19.5 vs. 105.8±31.2 hours). No postoperative air leak occurred in the capitonnage group, whereas air leak was observed in 46% of patients without capitonnage (P=0.04). Although empyema and pleural effusion were more frequent in the non-capitonnage group, the differences were not statistically significant. Conclusion: Capitonnage in addition to cystotomy and bronchial fistula closure was associated with shorter hospitalization, reduced chest tube duration, and fewer postoperative air leaks. Baseline demographic and clinical characteristics were comparable between both groups. These benefits were observed despite similar baseline characteristics between groups. These findings support the use of capitonnage as an effective adjunct in the conservative surgical treatment of pulmonary hydatid cysts, although further larger randomized studies are needed to confirm its benefits. Copyright © 2026 Vahedi et al. Published by Tehran University of Medical Sciences. This work is licensed under a Creative Commons Attribution-Non-Commercial 4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited.