Laparoscopic Treatment of Nonparasitic Liver Cysts: Adequate Selection of Patients and Surgical Technique

Abstract

Results of laparoscopic fenestration in patients with a highly symptomatic solitary liver cyst (17 patients) or polycystic liver disease (PLD) (9 patients) were prospectively evaluated in a multicenter practice of general surgeons. Conversion to laparotomy was required in two patients because of inaccessible deep liver cyst in one and a diffuse form of PLD in the other. There was no mortality or major morbidity. Mean postoperative hospital stay was 4.6 days after successful laparoscopic procedures. During a mean follow-up of 9 months, 23% of the patients had recurrence of symptoms and 38% had radiographic reappearance of cysts. Factors predicting failure included previous surgical treatment, deepsited cysts, incomplete deroofing technique, location in the right posterior segments of the liver, and a diffuse form of PLD with small cysts. Adequate selection of patients and type of cystic liver disease and meticulous and aggressive surgical technique are recommended.

Single-session alcohol sclerotherapy in symptomatic benign hepatic cysts performed with a time of exposure to alcohol of 10�min: initial results

“…The etiology, physiology, anatomy, occurrence, and surgical treatment of liver cysts have been outlined by other authors [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]. Aspiration of cystic fluid without sclerotherapy does not result in a permanent reduction of volume, and the relief of symptoms is only temporary [17]; however, during the past two decades several authors have reported on satisfactory results of ethanol sclerotherapy replacing surgery as the method of choice in solitary symptomatic cysts.…”

Surgical Management of Simple Liver Cysts: A 10-Year Single-Center Experience

“…Our results are consistent with the literature in this respect. Reported cyst recurrence rates following laparoscopic fenestration of SLC range between 8% and 25% [3,5,[11][12][13][14][15]. Recurrence has been linked to incomplete unroofing, laparoscopic unroofing of a recurrent cyst which almost always has adhesions making complete deroofing difficult, deep location of the cyst and posterior segment cysts [1].…”

“…We observed one (9%) asymptomatic recurrence at 17.4 months following laparoscopic fenestration. Predictors of recurrence include incomplete fenestration, previous operative treatment, deep-seated cysts, and cysts located within the posterior liver segments [1,13].…”

“…Due to the limited number of patients and follow-up SNP data available, comparisons of the various operative techniques have been sub-optimal and the optimum surgical management of SLC has not been clearly established [1] [3,5,[11][12][13][14][15]. This study evaluates our experience in a single-center over 10 years to determine the optimum operative treatment for SLC.…”

Advances in Laparoscopic Surgery

“…Their LU still lingers at pioneer's level in the innovation period. On the other hand a great number of articles have already been published about the deroofing and fenestration of 612 Digestion 1998;59:606- 618 Périssat/Collet/Monguillon congenital liver cysts [66,67]. This procedure is perfectly feasible in the hands of any surgeon with a good command of LC.…”