Laparoscopic deroofing of recurrent giant echinococcal and simple liver cysts in Uganda: a case series

Abstract

Introduction and importance: Liver cysts are a common liver disease, classified into simple and complex cysts. Simple liver cysts present the commonest benign liver disease while echinococcal liver cysts are part of the complex cysts found among pastoral communities. Liver cysts usually become symptomatic when they increase to sizes >5 cm that require percutaneous drainage, open or laparoscopic surgical intervention. Laparoscopic liver cyst deroofing with or without omentoplasty is not routinely practiced in resource-limited settings. Case presentation: Case 1; a 22-year-old female with a recurrent echinococcal liver cyst diagnosed by contrasted abdominal computed tomography scan, and case 2; a 71-year-old female with a recurrent simple liver cyst. Both patients had undergone prior ultrasound-guided cyst drainage. For case 1, PAIR (puncture, aspiration, injection, and reaspiration) was done by injecting 20% hypertonic saline to inactivate the scolocides before cyst deroofing. Omentoplasty was not done in both patients but the remnant cyst cavities in each case were cauterized to minimize recurrence. Both patients were discharged on the sixth and second postoperative days, respectively, without complications. Clinical discussion: Laparoscopic and open deroofing, enucleation, excision, and rarely hepatectomy have less recurrence rates for liver cysts than percutaneous drainage. These 2 reported cases had undergone ultrasound-guided drainage but had cyst recurrence. Laparoscopic liver cyst deroofing with cyst cavity cauterization with or without omentoplasty has good outcomes. Conclusion: We therefore, report successful laparoscopic liver cyst deroofing of recurrent giant echinococcal and simple liver cysts in Uganda and encourage this relatively new technique in our setting.