Recent trends in treatment of hepatic non parasitic cystic lesions: Outcome of laparoscopic management

Abstract

Background: Hepatic cystic lesions of non parasitic origin are mostly benign single, multiple, or diffuse cysts which contain clear serous fluid. Asymptomatic patients usually need no active treatment apart from follow up. In some patients, the cysts become painful and symptomatic which necessitate surgical intervention in the form of surgical deroofing or fenestration. Open surgical techniques used to be the treatment of choice since there is no harm to establish a free communication between the cyst and the peritoneal cavity because the cystic fluid contains no bile or microorganisms and its composition is similar to plasma. Recently, laparoscopic surgery is the treatment of choice as it can give similar results with less morbidity, and shorter hospital stay. The aim of this study was to evaluate the postoperative morbidity and, the incidence of relapses in the laparoscopic treatment of non-parasitic hepatic cysts and with polycystic liver disease during one year of postoperative follow up. Patients and methods: From March 2005 to September 2009, twenty patients (18 patients with simple non-parasitic hepatic cysts and 2 patients with polycystic liver disease (PCLD) with few large cysts in the anterior hepatic segments) of a mean age of 42 years (range 23-62) and of both sexes (16 women and 4 men) underwent laparoscopic fenestration and deroofing at Ain Shams University Hospitals. Before embarking on surgery, routine investigations, US, CT and serological tests for hydatid disease were requested. Tumour markers and bacteriological, chemical and cytological examination of the cystic fluid aspirated under US-guidance were requested if needed. Results: Computed tomography with contrast enhancement revealed simple hepatic cysts in 18 cases with a mean diameter of 10 cm (range 5-14 cm). There were 8 in the left lobe (segment II and III) and 10 in the right hepatic lobe. Polycystic liver disease was seen in 2 cases with a mean cyst diameter of 8 cm (range 6-10 cm). The dominant cyst was in the right hepatic lobe in 1 case and in the left lobe in the other case. Serological test for hydatid was done and was negative for all cases. Laparoscopic deroofing was completed successfully in 16 cases and conversion was needed in 4 cases in which the cysts were deeply seated and inaccessible by the laparoscope. Open surgical deroofing was possible in 2 cases and left lateral segmentectomy was done in 2 cases. There was neither perisurgical mortality nor significant morbidity in this study. One year postoperative results showed recurrence of the cyst in two cases. Conclusion: Laparoscopy can be considered a safe and efficacious treatment for non-parasitic hepatic cysts and with polycystic liver disease.