Nicht-parasit�re Leberzysten Therapie�berblick mit Langzeitergebnissen

Abstract

Symptomatic nonparasitic cysts of the liver require surgical intervention. Seventy-one patients were treated between 1977 and 1993 at the Department of General Surgery, University of Vienna. Different surgical treatments were compared with regard to complications and recurrence. Interventional puncture led to recurrences in nearly all cases and represents only a palliative procedure. Surgical treatment consisted of either laparoscopic (n = 7) or conventional (n = 44) fenestration or excision. The rates of recurrence did not differ significantly (14% vs 9%). The laparoscopic procedure is successful not only in polycystic disease but also in solitary cysts. Wide deroofing and excision were equally effective. Laparoscopic therapy should be tried in all cysts initially, because it causes less stress than celiotomy. Because of the small number of laparoscopically treated patients in the literature and in the authors' own experience, the significance of the difference in outcome between the two methods could not be established. In more patients, further investigations should be carried out to ascertain whether the laparoscopic method is superior regarding surgical stress and recurrence. Cystojejunostomy (n = 3) and hepatic resection (n = 2) are reserved for special indications. One homologous liver transplantation was successfully carried out 6 months after cystojejunostomy because of a cholangiocellular carcinoma. Frequent postoperative ascites represented a persistent problem in only one patient. Two of three cases of postoperative infection with intraabdominal abscesses led to death. Altogether, 16 patients died, including seven because of malignancy and three because of septic complications of a Potter III syndrome.

Experience with different methods of treatment of nonparasitic liver cysts

“…No complications were seen in our patients following puncture and sclerotizing treatment, but the high rate of recurrence does not indicate any advantage of this procedure. We agree with Vogl et al [3] that interventional radiological methods can be recommended only for patients whose high-risk condition does not permit surgical intervention and in cases in which diagnostic cytological tests are needed simultaneously with the aspiration.…”

“…They are more frequent in women than in men. In the majority of cases the results of liver function tests are within the normal range [3], as was the case in our patients. Opinions in the literature differ as to the necessity and the method of treatment of liver cysts.…”

“…The simplest method of treatment is US or CT-guided percutaneous aspiration. This is used mainly to mitigate acute complaints, as the rate of complications is high, and there is a high probability of recurrence of the cysts [3,6,9,10,11,12,13]. A number of authors suggest the sclerotization of liver cysts with ethoxysclerol or with absolute alcohol, while others report favorable experience with drainage [14,15,16] However, El Mouaaouy et al [15] observed a 6% rate of complications, including very grave ones.…”

“…The percutaneous puncture of liver cysts is likewise a routine procedure [3]. The simplest method of treatment is US or CT-guided percutaneous aspiration.…”

“…Liver cysts are frequently detected incidentally during imaging examinations. A number of surgical treatments and interventional radiological methods have been proposed, but there is no general international consensus as to optimal treatment [2,3]. Due to the development of minimally invasive techniques laparoscopic fenestration has become feasible in recent years [1,2,4,5,6,7].…”