Laparoscopic fenestration in polycystic liver disease

Sixteen laparoscopic cyst fenestrations for symptomatic adult polycystic liver disease (APLD) were performed in 13 women, including four patients who had had previous attempts at treatment (percutaneous sclerotherapy in two and fenestration via a laparotomy in two). The median number of cysts deroofed was 32 (range 18-58) during the 13 primary procedures. There was no in-hospital death. Postoperative transient ascites occurred in six patients. After operation 11 patients experienced immediate relief of symptoms but during a median follow-up of 26 (range 6-49) months, eight of these patients developed recurrent symptoms. Two patients underwent three repeat laparoscopic fenestrations, at which time perihepatic adhesions were rare and no complication occurred. Because repeat procedures may be performed, laparoscopic fenestration appears to be useful for the treatment of symptomatic APLD. However, it is less effective than fenestration at open surgery or liver resection and should be employed only in patients with predominantly large cysts.