Laparoscopic Hepatic Lobectomy for Symptomatic Polycystic Liver Disease

Abstract

Introduction: Laparoscopic fenestration has largely replaced open fenestration of liver cysts. However, most hepatectomies for polycystic liver disease (PCLD) are performed open. Data on laparoscopic hepatectomy for PCLD is lacking. We present a series of patients who underwent laparoscopic hepatectomy for symptomatic PCLD. Methods: A retrospective review of patients who underwent surgery for PCLD at a single institution between 2010 and 2019 was performed. Patients were grouped based on operative approach. Pre- and post-operative volumes were calculated for patients who underwent resection. The primary outcomes were: volume reduction, re-admission and postoperative complications. Results: Twenty-six patients were treated for PCLD: 13 (50%) with laparoscopic fenestration, nine (34.6%) with laparoscopic formal hepatectomy, three (11.5%) with open formal hepatectomy and one (3.8%) with liver transplantation. Average length of stay for the patients who underwent laparoscopic resection was 3 days (IQR 2-3.5), with no readmissions. One patient developed postoperative atrial fibrillation. There were no other complications. Overall volume reduction was 51.4% (22.3-68.5), 32.2% (range 22.3-46.7) after open resection and 56% (range 38.8-68.5) after laparoscopic resection. Average length of follow-up for the patients who underwent laparoscopic resection was 26 months (IQR 4-102). Conclusion: Performing hepatectomy for PCLD is challenging as anatomic planes and vasculature are distorted. The laparoscopic approach even more so due to limited working domain from hepatomegaly. Volume reduction achieved through laparoscopic approach is comparable to volume reduction in previously published open resection series, and exceeded open volume reduction at our institution. Adequate volume reduction can be accomplished by laparoscopic means with acceptable postoperative morbidity.