Laparoscopic approach for the treatment of symptomatic non-parasitic liver cysts is effective and minimally invasive

Andriani, Oscar; Grondona, J.; Secchi, Mario A.; Bracco, Ricardo; Russi, Rodolfo; Suhl, Arnoldo; Díez, José María Gutiérrez

doi:10.1016/s1365-182x(17)30719-0

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…To reduce recurrence risk, omentopexy is advocated in view of the hypothesis that omental tissue resorbs fluid and keeps the residual cavity open. Some authors cite specific indications to perform omentopexy such as a small exposed cyst wall, intrahepatic cysts, cyst size > 10 cm, cysts located posteriorly or in segment 7 and 8 or if < 50% of cyst wall can be resected [15, 39–45]. Other researchers refrain from omentopexy because of questionable evidence, similar recurrence rates without omentopexy, additional complications (e.g.…”

Section: Discussionmentioning

confidence: 99%

Clinical response after laparoscopic fenestration of symptomatic hepatic cysts: a systematic review and meta-analysis

et al. 2018

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Background Laparoscopic fenestration is one of the treatment options for symptomatic hepatic cysts, either solitary or in context of polycystic liver disease (PLD), but indications, efficacy and surgical techniques are under debate. Methods A systematic literature search (1950–2017) of PubMed, Embase, Web of Science and the Cochrane Library was performed (CRD42017071305). Studies assessing symptomatic relief or symptomatic recurrence after laparoscopic fenestration in patients with symptomatic, non-parasitic, hepatic cysts were included. Complications were scored according to Clavien–Dindo. Methodological quality was assessed by Newcastle–Ottawa scale (NOS) for cohort studies. Pooled estimates were calculated using a random effects model for meta-analysis. Results Out of 5277 citations, 62 studies with a total of 1314 patients were included. Median NOS-score was 6 out of 9. Median follow-up duration was 30 months. Symptomatic relief after laparoscopic fenestration was 90.2% (95% CI 84.3–94.9). Symptomatic recurrence was 9.6% (95% CI 6.9–12.8) and reintervention rate was 7.1% (95% CI 5.0–9.4). Post-operative complications occurred in 10.8% (95% CI 8.1–13.9) and major complications in 3.3% (95% CI 2.1–4.7) of patients. Procedure-related mortality was 1.0% (95% CI 0.5–1.6). In a subgroup analysis of PLD patients ( n = 146), symptomatic recurrence and reintervention rates were significantly higher with respective rates of 33.7% (95% CI 18.7–50.4) and 26.4% (95% CI 12.6–43.0). Complications were more frequent in PLD patients, with a rate of 29.3% (95% CI 16.0–44.5). Conclusions Laparoscopic fenestration is an effective procedure for treatment of symptomatic hepatic cysts with a low symptomatic recurrence rate. The symptomatic recurrence rate and risk of complications are significantly higher in PLD patients. Electronic supplementary material The online version of this article (10.1007/s00464-018-6490-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Clinical response after laparoscopic fenestration of symptomatic hepatic cysts: a systematic review and meta-analysis

et al. 2018

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“…In reported series with a follow‐up period exceeding 1 year, late cyst recurrence was observed in 0–28% [1,4, 19–22] and was 6% in our experience for the whole series during a mean follow‐up of 3 years, but was 0% in simple unilocular CLCs [13]. The worldwide reported experience with laparoscopic management of CLC in series exceeding 10 patients is detailed in Table 2 [1,4,8,12,13,19–29].…”

Section: Cystic Liver Diseasesmentioning

confidence: 80%

“…[1, 4, [19][20][21][22] and was 6% in our experience for the whole series during a mean follow-up of 3 years, but was 0% in simple unilocular CLCs [13]. The worldwide reported experience with laparoscopic management of CLC in series exceeding 10 patients is detailed in Table 2 [1, 4,8,12,13,[19][20][21][22][23][24][25][26][27][28][29].…”

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confidence: 93%

Laparoscopic management of benign liver diseases: where are we?

Gigot

Hubert

Banice

et al. 2004

HPB

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The role of laparoscopic surgery in the management of benign cystic and solid liver tumours appears to differ according to each tumour type. As regards congenital liver cysts, laparoscopic treatment is now the gold standard for treating selected, huge, accessible, highly symptomatic or complicated cysts. In contrast, the laparoscopic approach is not useful for patients suffering from adult polycystic liver disease (PLD), except for type I PLD with large multiple hepatic cysts. For benign hepatocellular tumours, the surgical management has recently benefited from a better knowledge of the natural history of each type of tumour and from the improvement of imaging techniques in assuring a precise diagnosis of tumour nature. Thus the general tendency has led to a progressive restriction and tailoring of indications for resection in benign liver tumours, selecting only patients with huge, specifically symptomatic or compressive benign tumours or patients suffering from liver cell adenoma. Despite the enthusiastic use of the laparoscopic approach, selective indications for resection of benign liver tumours should indeed remain unchanged. For all types of benign liver tumours, the best indication remains small, superficial lesions, located in the anterior or the lateral segments of the liver. Deep, centrally located lesions or tumours in contact with major vascular or biliary trunks are not ideal candidates for laparoscopic liver resections. When performed by expert liver and laparoscopic surgeons using an adequate surgical technique, the laparoscopic approach is safe for performing minor liver resections and is accompanied by the usual postoperative benefits of laparoscopic surgery. When applied in selected patients and tumours, laparoscopic management of benign liver diseases appears to be a promising technique for hepatobiliary surgeons.

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“…The prevalence of nonparasitic liver cysts in the general population is approximately 5% [1], and the majority are asymptomatic and found incidentally on imaging studies or fortuitously while operating for some other condition. Giant liver cysts (those 6 cm) are usually symptomatic due to their space occupying effects in the liver and can cause complications, such as spontaneous hemorrhage, biliary obstruction, rupture, and infection [2].…”

Section: Introductionmentioning

confidence: 99%