Operative management of non-parasitic liver cysts – A single centre experience

Abstract

Introduction: Non-parasitic liver cysts include Simple cysts, Multiple cysts in the setting of Polycystic disease and Cystic neoplasms. They are usually found as an incidental finding on imaging. Not more than 10-15% cause symptoms. Surgical management offers symptomatic relief with minimal morbidity. Methods: Retrospective analysis was made of patients with non-parasitic liver cysts who were managed surgically in the Institute of Surgical Gastroenterology, Madras Medical College over a period of 3 years. Patient demographics, symptoms, cyst characteristics, operative procedure, morbidity, mortality, length of hospital stay and histopathological diagnosis were analysed. Results: Between 2014 and 2017, 14 patients underwent surgery for symptomatic non-parasitic liver cysts. Majority were female. Mean age was 49 years. Abdominal discomfort was the predominant symptom. One patient had recurrent cyst. Preoperative diagnosis was simple cyst, multiple cysts and biliary cystadenoma in 8,4 and 2 patients respectively. The mean cyst diameter was 12.56 cm. Laparoscopic fenestration, open fenestration/partial excision and open resection were performed in 9,3 and 2 patients respectively. The recurrent cyst was diagnosed as choledochal cyst on histopathological analysis. Mean length of hospital stay was 6.71 days. Morbidity developed in two patients in the form of bile leak which was managed conservatively. There was no mortality. Conclusion: Laparoscopic fenestration is an effective treatment for symptomatic non-parasitic, non-neoplastic liver cysts. Open fenestration should be considered for recurrent cysts and those with difficult laparoscopic access. Resection is preferred for neoplastic liver cysts.