Symptomatic nonparasitic cysts of the liver

A retrospective study of 14 patients who had symptomatic congenital liver cysts managed at the Department of Surgery, University of Hong Kong at Queen Mary Hospital together with a literature review was conducted to evaluate the current surgical practice for the condition. Seven patients were managed either expectantly (N = 5) or by percutaneous aspiration (N = 2). Surgery which included total cystectomy (N = 3), external drainage (N = 1), and marsupialization with (N = 2) or without (N = 1) fenestration was done for the remaining 7 patients, among whom 1 developed bleeding after total cystectomy. While percutaneous aspiration provides adequate symptomatic palliation in selected patients, eventual recurrent cyst formation is frequent, especially when the cyst exceeds 10 cm in diameter. Despite technological advances, the presence of biliary communication and malignancy could not be accurately determined preoperatively. Careful examination of the cyst cavity at surgery remains the most reliable guide. Drainage into the peritoneal cavity in the presence of infection or bile content provides satisfactory drainage with minimal morbidity and mortality. Since total cystectomy could be done safely without partial hepatectomy, it can even be considered in patients with deeply-seated lesions. The role of aggressive hepatic resection or liver transplantation for the management of liver cysts remains to be validated by further clinical evaluation.