Laparoscopic Management of Symptomatic Multiple Hepatic Cysts: a Combination of Deroofing and Radical Excision

BACKGROUND: Liver cysts have been estimated to occur in 5% of the population. Multiple liver cysts can also be part of the polycystic disease complex. Only symptomatic or complicated cysts need surgery. Traditionally, laparotomy is the procedure of choice. We present our experiences with laparoscopic management of both symptomatic multiple liver cysts and polycystic liver disease. METHODS: Between 1995 and 2006, we treated 12 patients with large, multiple liver cysts, including 4 cases of polycystic liver disease. Most of the patients were elderly males. The lung and other organs were not involved in any case. Laparoscopic deroofing or radical excision with omentoplasty was successfully performed in these patients. RESULTS: Postoperatively, 4 patients had fluid draining through the drainage tube for an average of 10 days. One patient had ascites that resolved spontaneously. Cysts recurred in 5 patients. DISCUSSION: There are not many reports in the literature regarding large series of patients, further confirming the rarity of the disease. Liver cysts can occur as a part of polycystic renal and lung disease or isolated to the liver alone. Laparoscopic deroofing is the ideal treatment for nonpolycystic liver disease, and laparoscopic radical excision is ideal for polycystic liver disease. Simple needle aspiration or sclerotherapy is inadequate as recurrence is almost 100%. CONCLUSION: Currently, laparoscopy scores over laparotomy for the treatment of nonparasitic liver cysts as evidenced by this and other studies.