Background: Hepatic cysts are quite common, with a prevalence of up to 4-7% and a sharp rise with age. Although different classification schemes have been established, the simple distinction between true congenital and acquired cysts is more practicable. Most of liver cysts are asymptomatic and need no therapy. Only large and symptomatic require surgical intervention.Since when the laparoscopic treatment was performed, the fenestration has been widely used.Aim: The aim of this study is to present the outcome of laparoscopic fenestration of solitary cysts and polycystic liver disease.
Methods: Between May 2003 and August 2006, 13 patients with a nonparasitic cyst of the liver were selected for laparoscopic liver surgery. There were nine female (69.2%) and four male (30.8%). The average age of patients was 46.3 years (range, 35-59 years). All patients were symptomatic. Presenting complaints included right upper quadrant pain and symptoms related to compression to adjacent organs. All patients underwent preoperative ultrasonography or computed tomography. Simple cyst were observed in ten patients (76.9%) and polycystic liver disease in three patients (23.1%). The average size of the simple cysts was 11,3 cm (range, 9.5-17 cm), while the cysts of the patients with polycystic liver disease had an average diameter of 7.3cm. The liver function tests were performed in all patients. The Lin technique was performed in all cases. Giant liver cyst was approached by the dome that was opened using scissors, and the fluid was aspirated and sent for pathology. The cyst cavity was examined for the presence of neoplastic changes. Careful hemostasis of the cyst edge was performed with eletrocautery. A drain was placed in the residual cavity at the completion of the procedure.
Results: Laparoscopic fenestration was successfully completdd in all patients. The average operative time was 85 min (range, 53-110 min). There were no intraoperaive complications and no need for blood transfusion. The length of hospital stay was 3.5 days (range, 2-9 days). Recurrence was observed by computed tomography in one patient with polycystic liver disease after two years of laparoscopic surgery. At histopatological examination teh cystic wall show no malignant changes. There was no death in the entire series.
Conclusion: Laparoscopic fenestration is a procedure wit low morbidity and is recommended for the treatment of nonparasitic liver cysts.