[Laparoscopic fenestration in the management of symptomatic polycystic liver disease]

We report the case of a 70-year-old woman with polycystic disease of the liver and kidney, complicated with rupture and hemorrhage of the hepatic cysts located in the right lobe. A laparoscopic approach was used. After identifying the polycystic mass, the cytologic examination of the aspirated hematic fluid and the intraoperative biopsy showed its benign nature. An hepatic fenestration was performed. Hemostasis was achieved by electrosurgical and argon probes. The postoperative course was satisfactory and radiological improvement was demonstrated on the CT scan 3 months later. Follow-up examination one year later has been uneventful. Fenestration is one of the less stressing surgical options in the adult polycystic liver disease when treatment is indicated. The laparoscopic approach may be used with safety to perform a similar technique in selected cases, establishing a communication between the cysts and the peritoneal cavity. Nevertheless, it may be difficult to reach deeply situated cysts and to differentiate them from vascular structures. Laparoscopic intraoperative ultrasonography might be of great value in these cases. Likewise, long term studies are needed to determine the benefits and the indications of the laparoscopic fenestration.