Abstract
BackgroundSimple hepatic cysts (SHC) may cause pain and bloating and thus impair quality of life. Whereas current guidelines recommend laparoscopic cyst deroofing, percutaneous aspiration and sclerotherapy (PAS) may be used as a less invasive alternative. This review aimed to assess the efficacy of PAS and surgical management in patients with symptomatic SHC. MethodsA systematic search in PubMed and Embase was performed according to PRISMA-guidelines. Studies reporting symptoms were included. Methodological quality was assessed by the MINORS-tool. Primary outcomes were symptom relief, symptomatic recurrence and quality of life, for which a meta-analysis of proportions was performed. ResultsIn total, 736 patients from 34 studies were included of whom 265 (36%) underwent PAS, 348 (47%) laparoscopic cyst deroofing, and 123 (17%) open surgical management. During weighted mean follow-up of 26.1, 38.2 and 21.3 months, symptoms persisted in 3.5%, 2.1%, 4.2%, for PAS, laparoscopic and open surgical management, respectively. Major complication rates were 0.8%, 1.7%, and 2.4% and cyst recurrence rates were 0.0%, 5.6%, and 7.7%, respectively. ConclusionOutcomes of PAS for symptomatic SHC appear to be excellent. Studies including a step-up approach which reserves laparoscopic cyst deroofing for symptomatic recurrence after one or two PAS procedures are needed.
Highlights
Simple hepatic cysts (SHC) are the most commonly diagnosed benign liver lesions and are found in 18% of the general population on abdominal CT imaging for unrelated pathology.[1,2,3]This paper is not based on a previous communication to a society or meeting. * Shared first authorship. ** Shared senior authorship.Simple SHC do not include parasitic and polycystic SHC, occur more frequently in women, and have an incidence which increases with age.[4]
This review aims to assess the outcome of percutaneous aspiration and sclerotherapy (PAS) and surgical management as firstline treatment in patients with symptomatic SHC
This systematic review demonstrated that outcome of PAS for symptomatic SHC appears to be excellent with symptoms persisting is less than 4% of patients and complication and recurrence rates each
Summary
Simple hepatic cysts (SHC) are the most commonly diagnosed benign liver lesions and are found in 18% of the general population on abdominal CT imaging for unrelated pathology.[1,2,3]This paper is not based on a previous communication to a society or meeting. * Shared first authorship. ** Shared senior authorship.Simple SHC do not include parasitic and polycystic SHC, occur more frequently in women, and have an incidence which increases with age.[4]. Simple hepatic cysts (SHC) may cause pain and bloating and impair quality of life. This review aimed to assess the efficacy of PAS and surgical management in patients with symptomatic SHC. Primary outcomes were symptom relief, symptomatic recurrence and quality of life, for which a meta-analysis of proportions was performed. Results: In total, 736 patients from 34 studies were included of whom 265 (36%) underwent PAS, 348 (47%) laparoscopic cyst deroofing, and 123 (17%) open surgical management. During weighted mean follow-up of 26.1, 38.2 and 21.3 months, symptoms persisted in 3.5%, 2.1%, 4.2%, for PAS, laparoscopic and open surgical management, respectively. Studies including a stepup approach which reserves laparoscopic cyst deroofing for symptomatic recurrence after one or two PAS procedures are needed
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