Laparoscopic Treatment of Hepatic Cysts: A 10-Years Single Institution Experience

Aims: This study presents our experience in the laparoscopic management of simple hepatic cysts (SHCs) and the polycystic liver disease (PCLD).

Study Design: Retrospective institutional study.

Place and Duration: Department of Medical and surgical Science, University of Foggia, Foggia, from January 2004 to December 2014.

Methodology: Laparoscopic deroofing was performed in 20 consecutive patients. There were 15 cases with SHCs and only 5 cases with PCLD (Gigot’s type I). In SHCs group, cyst was single in 10 cases and multiple in 5. Cysts were located in both hepatic lobes in 4 cases. The two groups were homogeneous for age, sex and ASA score. Preoperative investigations include routine laboratory tests, ultrasonography and the use of computed tomography in order to make diagnosis ad to rule out parasitic and neoplastic liver cysts. CT scan was performed in all cases to assess the characteristics, dimensions, and exact position of the lesion. Surgery was planned for all patients because of evident and persistent symptomatology, characterized of the presence from no less of 6 months of typical symptoms such as nausea, vomiting and epigastric pain. In our series, 6 cases of cholelithiasis were associated.

Results: The analyzed outcome variables included surgical procedure, operative time, blood loss, length of hospital stay, complications, and medium follow-up period. All the patients underwent laparoscopic deroofing of the larger cysts and puncturing of the smaller cysts. There were no conversions. The mean operative time was estimated twice in the group PCLD than SHCs (110 min vs 60 min). The histological examinations revealed the typical pattern of the simple liver cysts in any case, without evidence of malignancy. No significant blood loss was found.

The total morbidity recorded was 25% (5/20), 2 cases in the group of SHCs (13,3%) and 3 cases in the PCLD one (60%) and was characterized of 2 cases of ascites through trocar insertion sites after removal of drainage tube and 3 case of pleural effusion. There were no significant group differences in term of length of hospital stay. The follow-up period (a mean of 22 months) confirmed that all the patients remained free of symptoms and relapse of the disease.

Conclusion: The technical feasibility and the good short- and medium-term results made the laparoscopic approach the procedure of choice for the management of symptomatic liver cysts.