Tailoring the Management of Nonparasitic Liver Cysts

Abstract

ObjectiveTo determine the optimal management of symptomatic nonparasitic liver cysts. Summary Background DataManagement options for symptomatic nonparasitic liver cysts lack substantiation through comparative studies with respect to safety and long-term effectiveness. MethodsA retrospective review of the surgical management of patients with hepatic cysts between October 1988 and August 1997 was undertaken to determine morbidity rates and to assess long-term recurrence. ResultsThirty-eight patients (35 women, 3 men) underwent 48 operations for symptomatic hepatic cysts of mean diameter 12 cm, with a mean follow-up of 41 months. Twenty-three patients had simple cysts, and 15 patients had polycystic liver disease (PCLD). The symptomatic recurrence rates after laparoscopic or open deroofing for simple cysts were 8% and 29%, and for PCLD 71 % and 20%, respectively. There were no symptomatic recurrences after 14 hepatic resections. There were no perisurgical deaths; however, morbidity rates were significant after laparoscopic deroofing, open deroofing, and hepatic resection (25%, 36%, and 50%, respectively).

Medical and surgical treatment options for polycystic liver disease1

“…One series compared complication rates after laparoscopic and laparotomic approach, and found that the latter procedure led to higher morbidity rates (29 versus 40%). 39 Main complications of fenestration were ascites, pleural effusion, arterial or venous bleeding, and biliary leakage. Overall morbidity in these patients was 23%.…”

Repeated Minocycline Hydrochloride Injections for Symptomatic Polycystic Liver Disease

“…In Japan, postoperative complications of liver resection include ascites, bile leakage, and intra abdominal abscess, with an incidence of 31.8% [59] . Cyst fenestration, i.e., surgical de roofing of a cyst, is a minimally invasive surgical treatment, but the recurrence rate has been reported to range from 20% to 72%, with large differences among previous studies [60][61][62][63] . The most commonly reported postoperative complication is ascites, with are latively high incidence of 33% to 69%.…”

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.…”

“…This series reported a morbidity rate of 58%, while in other series the morbidity rates range from 20% to 100%. The most commonly reported morbidities are ascites, pleural effusions, transient biliary leaks, bleeding, and wound infection [2,43,[47][48][49][50][51][52] . Que and coauthors had excellent results with an extremely low recurrence rate with 30 out of 31 patients remaining asymptomatic at a median follow-up of 28 mo.…”