The laparoscopic treatment of non-parasitic liver cysts. Five years experience

The incidence of cystic liver lesions seems to be more frequent as previously suggested. The treatment of symptomatic non-parasitic cysts is controversial. Ultrasonography (US) or computer tomography (CT) guided drainage and/or sclerotization versus surgical fenestration or partial resection, even liver resection has been advocated. Recently with the development of laparoscopic surgery this minimal invasive approach was also applied in the surgical treatment of single or multiple cystic lesions. Between 1994 and April 1999 21 patients with non-parasitic cysts were treated by laparoscopic fenestration or partial resection at the 1st Department of Surgery, Semmelweis University of Medicine. In 13 cases the symptomatic cyst presented the indication for surgery, while in the others cholelithiasis and GERD was the primary cause of intervention in 7 and 1 patient respectively. There were 16 woman and 5 men with a mean age of 42.3 years (17-78). The cyst was solitary in 17 cases and multiple 3-6-number in four patients. The size varied between 1.5-25 cm (average 7.2 cm). Patients were selected for the laparoscopic approach according to the US and/or CT appearance and superficial localization of the cyst. Wide unroofing or partial resection of the cyst wall till the margin of normal liver tissue was performed in all cases. The cystic cavity was drained. All operations were completed laparoscopically. Intraoperative complication did not occur. Bleeding from the resected margin could be well controlled by electrocautery or clipping. Patients left the ward after the drains were removed on postoperative day 2-4 depending upon the amount of serious discharge. No complication was observed postoperatively. During the average of 12.5 months (1 to 54 months) follow-up of 19 patients no recurrence was observed. Two patients required reoperation. In one 17 year old male patient cystadenocarcinoma was verified by histology, upon reoperation the lesion was found unresectable. In another case left hemi-hepatectomy was performed because of cyst recurrence caused by cholangiocell adenoma. In selected cases of superficially located symptomatic, non-parasitic cysts the laparoscopic fenestration might be the first choice of treatment. The method is safe and effective in the hands of surgeons experienced in both laparoscopic and liver surgery. Careful exploration of the cystic cavity and histological examination of the resected cyst wall is mandatory to avoid diagnostic mishaps.