Laparoscopic surgery and polycystic liver disease: Clinicopathological features and new trends in management

Abstract

BACKGROUND:Polycystic liver disease (PLD) has a low frequency overall in the worldwide population. As the patient's symptoms are produced by the expansion of hepatic volume, the different therapeutic alternatives are focused on reducing it. Surgery is still considered the most effective treatment for symptomatic PLD. The aim of this study was to evaluate the long-term outcomes of laparoscopic surgery for PLD.MATERIALS AND METHODS:This study included 14 patients who were diagnosed with symptomatic PLD and underwent surgery by a laparoscopic approach between 2004 and 2012. It involved collecting data on the characteristics of those patients and their liver disease, surgical procedures, intra- and postoperative complications, and the long-term follow-up.RESULTS:Twelve laparoscopic multiple-cyst fenestrations and two segmentary liver resections associated with remaining-cyst fenestration were performed. One procedure required conversion to laparotomy and the other was complicated by anhepatic severe bleeding. The rest of the procedures were uneventful. One patient developed persistent self-limited ascites in the immediate postoperative period. Symptoms disappeared after surgical intervention in all patients. During a median follow-up of 62 months (range 14-113 months), there were two clinical recurrences and one asymptomatic radiological recurrence. One patient required further surgery.CONCLUSION:Laparoscopic cystic fenestration and laparoscopic liver resection are safe and long-term, effective procedures for the treatment of symptomatic PLD. Severity and morphological characteristics of the hepatic disease will determine the surgical indication and the optimal approach for each patient.

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

“…In view of the limited benefit, the customary use of omentopexy with laparoscopic fenestration is questionable. Other options are in development to curtail cyst recurrence after deroofing such as ethanol sclerotherapy [50–53], argon beam coagulation [54, 55] or wide electrocoagulation [56], but evidence to support their use is limited and the provided data were not sufficient to perform a subgroup analysis of these techniques.…”

Laparoscopic hepatic lobectomy for symptomatic polycystic liver disease

“…17 In a recent case series of 14 patients treated for symptomatic PCLD, two patients underwent laparoscopic segmental liver resections while the remainder underwent laparoscopic fenestration. 23 Average length of stay for this series was 3.7 days, but outcomes were not reported based on procedure in this series. There are no prior studies as of yet that evaluate the volume reduction or long-term durability achieved in laparoscopic resection for symptomatic PCLD.…”

Hepatic Cysts as a Manifestation of Polycystic Kidney Disease (Polycystic Liver Report of 2 Mother-Son Cases)

“…The treatment suggested by some authors is partial liver resection, fenestration, aspiration, sclerotherapy, or liver transplantation, which may be a therapeutic option in some cases; In this patient, it has not been possible to perform any of these treatments due to poor control of diabetes and her glomerular filtration rate is less than 50%, which is why surgery is awaited [19][20][21].…”