Abstract
BackgroundHepatic cyst disease is often asymptomatic, but treatment is warranted if patients experience symptoms. We describe our management approach to these patients and review the technical nuances of the laparoscopic approach. MethodsMedical records were reviewed for operative management of hepatic cysts from 2012 to 2019 at a single, tertiary academic medical center. ResultsFifty-three patients (39 female) met the inclusion criteria with median age at presentation of 65 years. Fifty cases (94.3%) were performed laparoscopically. Fourteen patients carried diagnosis of polycystic liver disease. Dominant cyst diameter was median 129 mm and located within the right lobe (30), left lobe (17), caudate (2), or was bilobar (4). Pre-operative concern for biliary cystadenoma/cystadenocarcinoma existed for 7 patients. Operative techniques included fenestration (40), fenestration with decapitation (7), decapitation alone (3), and excision (2). Partial hepatectomy was performed in conjunction with fenestration/decapitation for 15 cases: right sided (7), left sided (7), and central (1). One formal left hepatectomy was performed in a polycystic liver disease patient. Final pathology yielded simple cyst (52) and one biliary cystadenoma. Post-operative complications included bile leak (2), perihepatic fluid collection (1), pleural effusion (1), and ascites (1). At median 7.1-month follow-up, complete resolution of symptoms occurred for 34/49 patients (69.4%) who had symptoms preoperatively. Reintervention for cyst recurrence occurred for 5 cases (9.4%). ConclusionsOutcomes for hepatic cyst disease are described with predominantly laparoscopic approach, approach with minimal morbidity, and excellent clinical results.
Highlights
Hepatic cysts are found in 2.5–18% of the general population and carry a broad differential diagnosis[1,2]
The aim of this study is to describe our experience and outcomes of non-infectious hepatic cyst disease management at a tertiary hepatobiliary center where the laparoscopic approach is standard
Fourteen (26.4%) patients carried a diagnosis of polycystic liver disease (PCLD)
Summary
Hepatic cysts are found in 2.5–18% of the general population and carry a broad differential diagnosis[1,2]. Cystic neoplasms of the liver include entities such as biliary. Abstract accepted for poster presentation at The Society for Surgery of the Alimentary Tract, 61st Annual Meeting, Session: SSAT Biliary Tract Diseases III (Final ID: Tu2046). Non-infectious hepatic cyst disease is often an incidental finding on abdominal imaging or during abdominal surgery performed for other reasons. In spite of the fact that hepatic cysts are fairly prevalent, only 5–10% of patients become symptomatic[4]. Symptoms of non-infectious hepatic cyst disease can arise insidiously and may progress to debilitating abdominal pain, nausea, vomiting, and early satiety. Patients can present with a more acute course due to cyst hemorrhage, rupture, or infection[5]. Hepatic cyst disease is often asymptomatic, but treatment is warranted if patients experience symptoms. We describe our management approach to these patients and review the technical nuances of the laparoscopic approach
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