Laparoscopic Management of Symptomatic Nonparasitic Cysts of the Liver Indications and Results

Abstract

ObjectiveThis clinical study evaluated the results of and defined the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse. Summary Background DataDifferent surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection, and liver transplantation. The advent of laparoscopic surgery has given new opportunities but, at the same time, has increased the uncertainties concerning the proper management of these patients. MethodsEight patients with solitary cysts and nine with polycystic liver and kidney disease (PLD) were seen during a period of 2 years. After a careful review of the symptoms, 6 patients were excluded from surgical treatment and 11 (4 solitary cysts and 7 PLD) were treated by laparoscopic fenestration. Postoperative morbidity and mortality rates, hospital stay, and clinical early and late results were evaluated. ResultsIn the solitary cyst group, there was no surgical morbidity or deaths, and a complete regression of symptoms occurred in all patients. No recurrences were observed. In the PLD group, two patients had to be converted to laparotomic fenestration (28%). There were no deaths, and the surgical morbidity was limited to two cases of postoperative ascites. Symptomatic relief was obtained in 80% of patients, but the symptoms recurred in 60%. A subgroup of PLD at high risk for recurrence was identified. ConclusionsThe best indications for laparoscopic fenestration seem to be solitary cyst and PLD characterized by large cysts mainly located on the liver surface (type 1), whereas PLD characterized by numerous small cysts all over the liver (type 2) should be considered a contraindication to laparoscopic fenestration. 157

Results of percutaneous sclerotherapy and surgical treatment in patients with symptomatic simple liver cysts and polycystic liver disease

“…Percutaneous drainage of the cyst only results in temporary relief of abdominal pain and may be used as a trial treatment, to determine whether abdominal symptoms are attributable to the cyst [15] . For definitive treatment, concomitant instillation of tetracycline or ethanol in the cyst is applied to ablate the epithelial lining of the cyst which reduces recurrence remarkably [3,16] .…”

“…In previous reports, laparoscopic approach of cysts located in segments Ⅵ, Ⅶ and Ⅷ were considered a contraindication for this non-invasive procedure [15,18] . However, according to a recent study, location of the cyst should not be a contraindication anymore for a laparoscopic procedure [4] .…”

Case‐matched analysis of totally laparoscopic versus open liver resection for HCC: Short and middle term results

“…Laparoscopic liver procedures were first described in 1990s, including biopsies and fenestration of cysts [2,3]. First hepatic wedge resection was performed in 1992 and, since then, the availability of new surgical instruments and modern anaesthesiological techniques, as well as the increased expertise in laparoscopic field, allowed the diffusion of laparoscopic approach for resection of liver lesions.…”

Surgical management of polycystic liver disease

“…With the introduction of laparoscopy, there are increasing numbers of reports of laparoscopic fenestration of patients with PCLD [24,25,[41][42][43][44][45][46] . It can be performed with similar morbidity and mortality as the open fenestration, but this approach must be utilized in the appropriate population.…”

“…Patients with majority of their cysts in segments Ⅵ, Ⅶ, and often Ⅷ (when there is marked hepatomegaly) and patients with deeply seated cysts that are difficult to visualize and fenestrate with laparoscopy may be better candidates for open fenestration. From the published series, these patients have a higher recurrence rate after laparoscopic fenestration due to the inability to adequately fenestrate all of their cysts [42,43,46] . The 13 published series describing open and/or laparoscopic fenestration are summarized in Table 1.…”