Management of symptomatic liver cysts

Non-parasitic liver cysts are seen in up to 5% of the population. They become symptomatic when they are large and can cause pain, nausea, vomiting, early satiety and obstructive jaundice. Treatment modalities include percutaneous drainage, open deroofing, hepatic resection and lately, laparoscopic deroofing. We assessed our management of eleven symptomatic patients over the last five years between May 1996 and August 2001. Two of these had mild symptoms and were kept under review. The remaining nine were treated surgically. Of these, eight were treated by laparotomy and open deroofing with argon laser coagulation of the cut edges while one was treated with left hepatic resection. Three of these had been previously treated with laparoscopic deroofing at other hospitals and had been referred after having developed recurrent symptomatic cysts. Two patients developed post-operative complications--bile leakage that resolved with conservative management. The patients were followed up for a median period of twelve months ranging from 3-62 months. One patient died of liver failure 12 months after surgery. There was no symptomatic recurrence. We conclude that open cyst deroofing gives marked symptomatic relief with a very low complication rate. In today's era of laparoscopic surgery, it has a definite role in the management of symptomatic liver cysts, more so in recurrent cysts following laparoscopic treatment.