[Laparoscopic treatment of non parasitic liver cysts]

Various surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection and liver transplantation. The advent of laparoscopic surgery has provided new opportunities but, at the same time, has increased the uncertainties concerning the correct management of these patients. This study evaluates the results and defines the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse. 31 patients were observed between November 1990 and October 1995: 15 with solitary cysts and 16 with policystic liver disease (PLD). After a careful review of the symptoms, 8 patients (5 with a solitary cyst and 3 with a PLD) were excluded from surgical treatment and 23 were treated by laparoscopic fenestration. There was no mortality. Ten of the 23 patients had a solitary cyst with a median diameter of 11.6 cm (range 6-20 cm). No conversion to laparotomy was necessary. There were no complications and complete regression of symptoms was obtained in all patients. No recurrences were observed. In the PLD group (13 patients), two patients had to be converted to open fenestration (15%). There were no deaths and the surgical morbidity was limited to two cases of postoperative persistent ascites. Symptomatic relief was obtained in 64% of patients, but symptoms recurred in 36%. A subgroup of PLD at high risk for recurrence was identified and a classification of PLD is proposed: PLD type I characterized by large cysts mainly located in the anterior hepatic segments, and PLD type II characterized by numerous small cysts through the liver which do not represent a good indication for laparoscopic fenestration.