Nonparasitic Cysts Research Articles

Laparoscopic treatment using an argon beam coagulator for nonparasitic liver cysts

Background Laparoscopic deroofing has been shown to produce good patient satisfaction and to have results similar to those of open surgical techniques. We evaluated the feasibility and efficacy of laparoscopic deroofing using an argon beam coagulator (ABC) in the patients with nonparasitic liver cysts. Methods Laparoscopic deroofing for the treatment of liver cysts was attempted on 14 patients. After the deroofing, the secreting epithelium within the residual cystic cavity wall was destroyed using the ABC. Results Laparoscopic deroofing was successful in all patients. No deaths or surgical morbidity occurred, and no postoperative complications were recorded. The median postoperative hospital stay was 7 days. The median follow-up was 56 months for all patients, and all patients have remained completely asymptomatic for 6 months after the surgery, with no recurrence of the cysts. Conclusions Our results indicate that laparoscopic deroofing using the ABC method in patients with nonparasitic liver cysts was effective in preventing cyst recurrence.

Laparoscopic Treatment of Large True Cysts of the Liver and Spleen is Ineffective

True epidermal cysts of the liver and spleen are uncommon and it has been recommended that laparoscopic management is appropriate. Often these cysts are large and centrally located by the time they reach clinical significance thereby making complete excision difficult without major liver resection or splenectomy. Definitive therapy consists of drainage and complete resection of the cyst wall. Three patients presented with upper abdominal pain. Workup revealed large non-parasitic true cysts of the liver (one) and spleen (two). All were initially treated with laparoscopic resection of their cysts with the primary objective being organ preservation. They were followed with periodic ultrasound/CT scanning. The pathology report in all three cases demonstrated benign congenital epithelial cysts and the patients did well postoperatively. Despite meticulous dissection and marsupialization of the cysts all three patients experienced recurrence that necessitated further therapy. We conclude that laparoscopic surgery is inadequate in the management of true cysts of the liver and spleen unless complete removal of all cyst wall can be assured.

Compression de la veine cave inférieure avec thrombose : une complication rare d'un kyste biliaire solitaire

Because of the increase of ultrasonographic exams, nonparasitic cyst of the liver is frequently encountered. Some giant cysts have complications. The surgical treatment for complicated forms consists in resection of the protruding part. We report a case of a giant non parasitic cyst of the liver which was responsible of a compression of the inferior vena caval with thrombus. The resection of the thrombus was performed after a double control of the veina cava and a control of the aorta. The fenestration of the cyst was performed in a second time.

Rapid dot-ELISA for the detection of specific antigens in the cyst fluid from human cases of cystic echinococcosis.

A rapid dot-ELISA was developed for the detection of specific antigens in samples of cyst fluid from human cases of Echinococcus granulosus infection, permitting the confirmation of cystic echinococcosis (CE). Peroxidase-conjugated antibodies against antigen B (derived from the fluid in the cysts of sheep infected with E. granulosus) were used to test cyst-fluid samples from 22, surgically confirmed cases of human CE and 21 domestic animals (horses, sheep, buffalo, a cow and a camel) with CE. All of these samples were found to be strongly positive in the dot-ELISA, by direct reading with the naked eye. In contrast, fluid samples from seven, non-parasitic liver cysts of human origin were all negative, and a sample taken from the residual cavity left in a patient after previous CE surgery showed a weakly positive reaction. The antigen-detection assay, which can be completed within 10 min, may be a useful 'bedside' test for the differential diagnosis of cysts during surgery or percutaneous treatment for suspected CE.

Experience with different methods of treatment of nonparasitic liver cysts.

In a search for the optimal management of nonparasitic liver cysts, a study was made of the effectiveness of different methods. Between 1 January 1982 and 15 December 2001 we treated 132 patients with nonparasitic liver cysts. In 72 patients 31 cysts were treated with enucleation, 60 with deroofing, and 24 with stitching by laparotomy; two liver resections were also performed. In a further 34 patients 36 cysts were treated with deroofing by minimally invasive surgery. In an additional 26 patients 32 cysts were treated with various interventional radiological methods. There was no mortality. The morbidity rate after laparotomy was significant (22.2%). The rate of recurrence after enucleation and deroofing was 6.5% and 13.8%, respectively, but there were no recurrences after stitching and liver resection. The recurrence rate following laparoscopic deroofing was 19.4%, and that following interventional radiological procedures was 50%. Treatment is required only if cysts are highly symptomatic or if growth is detected. Interventional radiological methods do not prove more favorable than surgery. Laparoscopic fenestration is preferred because of its low morbidity and the short period of hospitalization. Traditional surgical methods should be reserved merely for cases in which laparoscopic deroofing is not feasible.

Reply: Nonparasitic Splenic Cysts

Journal of the American College of Surgeons: September 2002 - Volume 195 - Issue 3 - p 438 doi: 10.1016/S1072-7515(02)01295-4

Nonparasitic splenic cysts: pathogenesis, classification, and treatment.

Nonparasitic splenic cysts (NPSCs) are uncommon lesions of the spleen, many being reported in anecdotal fashion. Early classifications of this disorder have been based on the presence or absence of an epithelial lining, indicating either a congenital or traumatic etiology. This criterion has led to confusion and mistaken reporting because the lining alone is not a reliable criterion. Over a 28-year period, the author has observed and studied 23 patients with NPSC. Special attention has been given to the role of trauma in the history, the nature (or absence) of a cyst lining, the gross pathology, and the preferred method of treatment. NPSC present as lesions with a very characteristic gross appearance and lining. The trabeculated interior can be lined with epidermoid, transitional, or mesothelial epithelium. Desquamation of the lining can lead to a spurious diagnosis, but careful search usually discloses the lining remnant. Although most NPSC in this series were treated by open partial splenectomy, the more recent approach by laparoscopic techniques offers great promise. A new classification of NPSC is offered, based on characteristic gross findings. NPSC are of congenital origin, with a lining derived from mesothelium. Trauma does not play a primary role in pathogenesis. Cysts that are symptomatic or over 5 cm in diameter should be removed by partial splenectomy or near-total cystectomy "decapsulation," either by the open or laparoscopic approach.

Symptomatic nonparasitic hepatic cysts: options for and results of surgical management.

Management options for symptomatic nonparasitic hepatic cysts (SNHC) lack verification through comparative studies with respect to safety and long-term effectiveness. Open cystectomy is the treatment of choice for patients with SNHC. University hospital department of surgery. Data were retrospectively analyzed from the clinical charts of 34 patients (26 women and 8 men) undergoing surgery for SNHC from January 1, 1975, through January 1, 1999. Charts were obtained from the original hospital referral. Morbidity rates and long-term recurrence. We considered the following variables for analysis: age, sex, hepatic cyst location, diameter of the cyst at primary surgery, symptoms, surgical procedure, postoperative morbidity and mortality, length of postoperative hospital stay, and long-term outcome. The 34 patients underwent 47 operations for SNHC (mean diameter, 15.0 cm), with a mean follow-up of 50.0 months. Ten patients underwent open and 8, laparoscopic deroofing of the cyst. Enucleation of the cyst and hepatic resections were performed as primary procedures in 4 and 2 patients, respectively, and as secondary procedures in 6 and 7 patients, respectively. Two recurrences (25%) were found after laparoscopic deroofing and 3 (30%) after open deroofing. Two (50%) and 6 (100%) recurrences were found after cystojejunostomy and needle aspiration, respectively. No symptomatic recurrences occurred after 10 cystectomies and 9 hepatectomies. One operative death (3%) occurred; however, morbidity rates were 18% (6/34) and 15% (2/13) after primary and secondary surgery, respectively. These results support our policy of performing open radical procedures in the treatment of SNHC; cystectomy is performed for primary surgery and hepatic resections for recurrences and complications. Conservative procedures have shown higher rates of recurrence and the need for further surgery. Only further technological improvements will allow a systematic and safe use of laparoscopy for radical surgery for SNHC.

Unusual case of giant non-parasitic hepatic cyst presenting as portal hypertension

Unusual case of giant non-parasitic hepatic cyst presenting as portal hypertension

Unilocular Hepatic Echinococcal Cysts: Sonography and Computed Tomography Findings

AIM: In endemic regions, unilocular hepatic echinococcal cysts (HEC) may be difficult to differentiate radiologically from simple non-parasitic cysts, especially if serological tests were negative. The aim of this descriptive study is to elucidate distinctive imaging findings that allow a diagnosis of HEC. MATERIALS AND METHODS: The sonographic and computed tomography (CT) findings of 21 patients with proven unilocular HEC were retrospectively analysed. A total of 28 examinations were reviewed, including 14 sonograms (ultrasound; US) of the liver and 14 CT studies. RESULTS: Seven imaging features that help in the diagnosis of unilocular HEC were identified by US and/or CT in 14 patients (14/21; 66.6%). They are, by order of frequency: hydatid sand (29.2%), focal or segmental thickening of the cyst wall (29.2%), coexistent echinococcal cysts in the spleen or lungs (16.6%), pericystic biliary radicles dilatation (8.3%), atrophy of the right lobe with compensatory hypertrophy of the left hepatic lobe (8.3%), satellite cysts typical of HEC in the liver (4.2%) and pericyst calcification (4.2%). CONCLUSION: These ancillary signs should prompt us to consider HEC as the cause of a unilocular cyst in approximately two-thirds of patients. Haddad, M. C. et al. (2001). Clinical Radiology56, 746–750.

Laparoscopic fenestration and modified marsupialization of posttraumatic splenic cysts using a harmonic scalpel

In recent years, the advanced laparoscopic experience has revolutionized surgery and fostered the expansion of the indications for minimally invasive surgery in the diagnosis and treatment of all intra-abdominal pathology. Total splenectomy, which traditionally was the procedure of choice in the treatment of symptomatic nonparasitic splenic cysts, recently has been changed to a more conservative approach by many authors [1, 5, 9]. The conservative methods preserve immunologic function of the spleen and prevent the potentially fatal postsplenectomy sepsis complications [9]. We successfully performed laparoscopic fenestration and modified marsupialization of these cysts using a harmonic scalpel on two patients with symptomatic splenic psuedocysts.

LAPAROSCOPIC PARTIAL NEPHRECTOMY WITH A MICROWAVE TISSUE COAGULATOR FOR SMALL RENAL TUMOR

LAPAROSCOPIC PARTIAL NEPHRECTOMY WITH A MICROWAVE TISSUE COAGULATOR FOR SMALL RENAL TUMOR

Treatments of non-parasitic giant hepatic cysts.

This retrospective study presents the results of surgical treatments for large cyst of the liver over 10 cm in diameter in 9 patients diagnosed and treated at Kurume University Hospital. There were 8 women and 1 man, with an average age of 71.6 years. Although the chief complaints were abdominal pain or fullness, 1 had obstructive jaundice due to biliary compression by a large cyst. Cyst size ranged from 10 cm to 27 cm. There are several treatment modalities for giant hepatic cyst, such as cyst resection, unroofing, and sclerotherapy after cyst drainage. Operative procedures in the patients reported here were surgical resection of the liver cyst in 3 patients, unroofing with ethanol sclerotherapy in 1 patient and laparoscopic treatment in 2 patients. Sclerotherapy after percutaneous transhepatic cyst drainage was performed in 3 patients because their general condition was poor. There were no postoperative complications among these patients. Costs varied among the patients and depended mainly on the method of treatment and period of hospital stay. We discuss operative procedures and costs of treatment of each patient and review the literature.

Solitary Non-parasitic Cyst of the Liver in a Neonate : A Case Report

Solitary Non-parasitic Cyst of the Liver in a Neonate : A Case Report

Hepatic Cysts.

Treatment of hepatic cysts should be considered only for those patients who are symptomatic. For simple cysts, percutaneous aspiration invariably leads to recurrence; laparoscopic deroofing is usually curative. Open deroofing (fenestration) should be reserved for cysts inaccessible by laparoscopy. Percutaneous instillation of sclerosing agents (ethanol, iophendylate, minocycline) into nonbiliary and nonparasitic cysts is an alternative therapeutic option in certain cases. Due to increased morbidity, hepatic resection should be reserved for polycystic liver disease, diffuse hepatic involvement, or recurrence after a deroofing procedure. Patients with congenital fibropolycystic disorders (eg, congenital hepatic fibrosis) with evidence of hepatic decompensation, should be considered for liver transplantation. For hepatic hydatid cysts, simple cystectomy or the PAIR (puncture, aspirate, inject, and reaspirate) technique with albendazole treatment have been shown to be equally successful. In the case of alveolar echinococcosis, hepatic resection and liver transplantation are the only effective modalities for localized and extensive hepatic disease, respectively.

Abordagem videolaparoscópica de cisto esplênico não parasitário

A rare case of primary splenic cyst is shown in a young woman who had a left subcostal abdominal pain. Abdominal echography and CT scan revealed a cyst of the anterior aspect of the spleen. A sorologic test for hidatic disease was negative. On the basis of a presumed diagnostic of nonparasitic cyst, the patient was referred to a laparoscopic decapsulation with excision of the cyst wall not covered by splenic tissue. The patient was discharged 24 hours later. Histological report revelead epidermoid cyst. The laparoscopic approach has being recently considered an effective and less invasive alternative in the treatment of splenic diseases. We demonstrated that it should be considered for the treatment of splenic cysts present in a superficial location, with the advantage of organ preservation.

Hepatobiliary and pancreatic: Commentary

Journal of Gastroenterology and HepatologyVolume 15, Issue 7 p. 812-812 Free Access Hepatobiliary and pancreatic: Commentary First published: 25 December 2001 https://doi.org/10.1046/j.1440-1746.2000.2238b.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat INTERPRETATION OF FIG. 1 1This cystic lesion is well demarcated and round in its cross section, suggesting that the cyst is filled with fluid as would be a unilocular non-parasitic liver cyst. However, there was some echogeneic material within the cyst that was mobile with changes in patient posture. It is possible that this echogeneic material represents biliary sludge or debris. Figure 1Open in figure viewerPowerPoint DIAGNOSIS: BILOMA SECONDARY TO MICROWAVE COAGULATION THERAPY This low echoic cystic lesion contains irregularly shaped echogeneic material. The contents of simple cysts of the liver are usually clear or opalescent and do not contain visible material. Because of the history of this patient, this cyst was not originally recognized at the time of surgery for local ablation therapy. Further, echinococcosis does not exist in the part of Japan in which this patient lives. It is therefore concluded that this lesion is related to the treatment that he had been given. In Fig. 2, a computed tomography scan of the liver shows an expanding cyst about to perforate. Bile ducts are connected to the cyst (arrowhead). The cyst contains some radiopaque material and beside the cyst, a new hepatocellular carcinoma lesion is seen in segment 4 (arrow). Figure 2Open in figure viewerPowerPoint Computed tomography scan. A bile duct is seen entering the cyst (arrowhead). A new hepatocellular lesion is found in S4 (arrow). Bile duct complications are common after liver transplantation, 1 blunt liver trauma, 2 laparoscopic cholecystectomy 3 and biliary surgery. In one study, 6% of 175 patients requiring hepatorraphy for liver trauma developed a biliary fistula or biloma. 2 Radioactive biliary imaging agents accumulate very slowly in bilomas. 3 Bilomas can also occur spontaneously, but very rarely. If a biloma occurs within the liver, it forms a pooling of bile. The outcome varies with each case, but the lesions frequently require surgical repair. REFERENCES 1 Lerut S, Gordon RD, Iwatsuki S et al. Biliary tract complications in human orthotopic liver transplantation. Transplantation 1987; 43: 47 51. 2 Howdieshall TR, Purvis J, Bates WB, Teeslink CR. Biloma and biliary fistula following hepatorraphy for liver trauma: incidence, natural history, and management. Am. Surg. 1995; 61: 165 8. 3 Sammak BM, Yousef BA, Gali MH, Al Karawi AM, Mohamed AE. Radiological and endoscopic management of bile leak following laparoscopic cholecystectomy. J. Gastroenterol. Hepatol. 1997; 12: 34 8. Volume15, Issue7July 2000Pages 812-812 FiguresReferencesRelatedInformation

Laparoscopic approach for the treatment of symptomatic non-parasitic liver cysts is effective and minimally invasive

Background Non-parasitic liver cysts are frequently observed, but only those that are symptomatic or complicated need to be treated. Laparoscopic deroofing can be performed with minor parenchymal trauma, avoiding complications of the large surgical wound of laparotomy. Some authors recommend an open surgical approach for those cysts located in the posterior segments of the liver. The aim of this study was to evaluate the results of laparoscopic deroofing of non-parasitic liver cysts. Methods A survey was carried out among several members of the Argentine Chapter of the IHPBA. The survey included details of surgical technique, peroperative complications, hospital stay, mortality and persistence or relief of symptom. Results Seventeen symptomatic patients were included. Twenty-four cysts were treated with wide deroofing. Two huge cysts located in the posterior segment of the right liver required a lateral approach. There were no conversions to open operation and no deaths. A low rate of mild complications was found (shoulder-tip pain in 2 patients). The mean hospital stay was 2 days (1–5 days). During a mean follow-up of 23 months (3–48 months), I patient developed recurrence (6%) and has been successfully re-operated by laparoscopy, while another still had a residual cyst cavity. Both patients are asymptomatic at 2 years. Discussion Laparoscopic approach for wide deroofing of symptomatic non-parasitic liver disease has demonstrated good results, even for large cysts in the right lobe, for which a lateral approach is advised. Omentoplasty is recommended in cases of large cavities. Re-operations may be feasible, since this procedure produces fewer adhesions than open operation.

Long-term results after laparoscopic unroofing of solitary symptomatic congenital liver cysts.

Reports about laparoscopic management of symptomatic nonparasitic liver cysts are increasing, proving the procedure feasible and safe. However, late results of endoscopic unroofing currently are not available. The primary aim of the study was to offer long-term results with a follow-up of more than 5 years. Two diagnostic pitfalls are presented. Preoperatively, diagnosis was established by sonography, computed tomography (CT) scan, echinococcus serology, and tumor-marker measurement. The outcome of 12 laparoscopic fenestrations in 11 patients with symptomatic solitary liver cysts is presented. Nine patients were reexamined after a median observation time of 3.1 years (range, 0.6-6.4 years) by clinical investigation and ultrasonography, CT scan, or magnetic resonance imaging (MRI), respectively. All operations could be finished laparoscopically, and no death occurred. Simultaneous cholecystectomy was performed in six cases. All patients experienced immediate relief of symptoms. Postoperatively, no complications were observed except one patient with unilateral brachial vein thrombosis. Histologically, we discovered one hydatide cyst and one cystadenoma underlying the cystic disorder leading to further therapy. At follow-up, one of the remaining seven patients (14.3%) suffered symptomatic recurrence and successfully underwent reoperation endoscopically. The results of this study confirm the outcome reported previously after short- and intermediate-term follow-up showing that laparoscopic management of symptomatic solitary nonparasitic liver cysts is permanently successful in a large majority of cases when diagnosis is correct.

EVALUATION OF THE TREATMENT FOR NONPARASITIC LIVER CYSTS BY ONE-TIME INTRACYSTIC INSTILLATIONS OF MINOCYCLINE HYDROCHLORIDE AND CARBON DIOXIDE UNDER ULTRASONICALLY GUIDED PUNCTURE

In the past 6 years 14 patients with large nonparasitic liver cysts were treated by intracystic instillation of minocycline hydrochloride or/and carbon dioxide under ultrasonically guided puncture. Six patients were treated with only minocycline hydrochloride and eight patients were treated with both minocycline hydrochloride and carbon dioxide. Four patients treated with minocycline hydrochloride experienced a shrinkage of cysts by more than 80%, but the remaining two showed a decrease in size by less than 70%. On the other hand, all eight patients treated with both minocycline hydrochloride and carbon dioxide obtained a shrinkage of cysts by more than 90%. There were no serious complications in this series, so safety and shortening of hospital stay by this method were confirmed. It is concluded that ultrasonically guided intracystic instillation of minocycline hydrochloride and carbon dioxide is more effective than their use singly. The treated cysts were reducing gradually and they finally obtained obvious shrinkage of the cysts. After all, we have to avoid premature evaluation of therapeutic efficacy, and therefore, have to follow up for at least a year without repeated injections.