Long-Term Outcome of Laparoscopic Decortication of Peripheral and Peripelvic Renal and Adrenal Cysts

Abstract

We determined the perioperative course of laparoscopic decortication of renal/adrenal cysts, and the association among cyst location, radiographic assessment and long-term symptom relief. Laparoscopic cyst decortication was performed 18 times in 17 patients for pain relief (1 patient had bilateral cysts) at our institution between August 1996 and June 1999. Of these patients 13 had single and 5 had multiple cysts, and 9 each had peripelvic and peripheral (includes 2 adrenal) cysts. Questionnaires were prospectively distributed to these patients preoperatively, 2 and 6 weeks postoperatively, and annually thereafter. Preoperative and postoperative radiographs were reviewed. Perioperative morbidity measures were similar to those previously published with minimal complications and a rapid recovery. Cyst location had no significant perioperative impact. Symptom relief occurred in 78% of cases overall. Median final symptomatic followup was 52 months. Radiographic success (complete absence of cyst) was 89% for the peripheral cyst group and 55% for the peripelvic cyst group (p = 0.29). Median radiographic followup was 23 months. Symptomatic failure occurred in 40% of the 5 radiographic failures and 15% of the 13 radiographic successes (p = 0.53). Laparoscopic decortication is a safe, minimally invasive and effective treatment for symptomatic renal cysts with durable response. Although peripelvic cyst location can make certain cases more difficult or even technically not feasible, perioperative measures and long-term outcome are generally equivalent. Symptomatic failure after complete cyst resection, as measured radiographically, is likely due to a misdiagnosis of the cause of symptoms.