Laparoscopic management of nonparasitic symptom-producing solitary hepatic cysts

In 1991, the first laparoscopic treatment of a nonparasitic solitary hepatic cyst was published. We now report a series of eight cases and describe a standardized minimally invasive technique.

Between October 1992 and December 1995, eight patients underwent laparoscopic surgical treatment for nonparasitic solitary hepatic cysts. Patients with polycystic hepatic disease were not included in our study.

Cyst diameters varied from 12 to 15 cm. The mean operation time was 114 minutes, and the mean postoperative hospital stay was 8.5 days. There was no morbidity or mortality. During the mean follow-up time of 12.6 months, one asymptomatic recurrence was noted.

The treatment of choice for solitary hepatic cysts that produce symptoms is laparoscopic fenestration and wide resection (deroofing) of the external part of the cyst followed by the transposition of an omental flap into the remaining cyst cavity to prevent recurrences. Laparoscopic deroofing of solitary hepatic cysts is a safe and effective procedure. This technique allows ample access for surgical treatment of solitary cysts in segments II, III, IVb, V, and VIII of the liver; however, the posterior segments, VI and VII, and segment IVa are difficult to approach laparoscopically. Hemorrhage and bile leakage can be controlled by applying a running suture to the resection margin. A cholecystectomy should be performed if gallstones are present or if the cyst is located in the right hepatic lobe adjacent to the gallbladder wall.