Selective lung ventilation in pediatric pulmonary hydatid cyst surgery: a comparative analysis of operative efficiency and clinical outcomes

Selective lung ventilation (SLV) during thoracic surgery improves surgical exposure and prevents contamination of the contralateral lung. In pediatric pulmonary hydatid cyst surgery, bronchopulmonary fistulas complicate surgical visualization and repair, significantly increasing the risk of contamination. This study aimed to evaluate the effectiveness of SLV in terms of operative time, prolonged air leak, reoperation necessity, and hospital stay duration in pediatric thoracotomy cases performed for hydatid lung cysts. This retrospective study included pediatric patients under 18 years of age who underwent thoracotomy for pulmonary hydatid cysts between 2014 and 2022. SLV was performed with double-lumen tubes in children aged seven years and older and with endobronchial blockers in younger children. Patients were grouped according to the type of ventilation (SLV or non-selective lung ventilation, NSLV), and variables such as cyst volume, operative time, postoperative complications, and hospital stay duration were compared. A total of 86 patients were analyzed, with 60 in the NSLV group (69.8%) and 26 in the SLV group (30.2%). Despite significantly larger cyst volumes in the SLV group (221.6 cm³ vs. 104.9 cm³, p = 0.048), SLV patients had notably shorter operative times (115.7 vs. 153.7 min, p = 0.001) and significantly reduced hospital stays (7.2 vs. 12.3 days, p = 0.05). No SLV-related complications such as atelectasis or infection were observed. This first pediatric-focused study demonstrates that SLV effectively reduces operative time and hospitalization without increasing complication rates, suggesting it as a reliable option in pediatric hydatid cyst surgery.