Original Article

Laparoscopic Management of Benign Nonparasitic Hepatic Cysts: A Prospective Nonrandomized Study

Authors: C Palanivelu, MCh, MNAMS, FACS, FRCS (Ed), Kalpesh Jani, MD, MS, DNB, MNAMS, Vijaykumar Malladi, MS

Abstract

Background: Nonparasitic benign hepatic cysts are relatively rare, and are usually detected fortuitously while investigating a patient for some other illness. However, they may reach huge proportions and present as an upper abdominal mass. With the advent of laparoscopy, a minimally invasive technique is available to manage these cases, which is described along with results and a discussion of the concerned literature.


Methods: Since 1995, 27 patients underwent cyst fenestration at our institution. The team setup, port placement, instruments and technique are described.


Results: All of our patients had a single cyst. Of the 27 patients, 17 were symptomatic with the most common complaint being upper abdominal distension and pain. Twenty patients had a right-sided cyst. In 16 patients, omentopexy was done to deal with the residual cavity. Eleven patients underwent simultaneous cholecystectomy. The average operating time was 72 minutes. There have been no recurrences after an average follow-up period of 7.2 years.


Conclusions: Laparoscopic management of congenital hepatic cysts has become the new gold standard, associated with minimum morbidity and good long-term outcome.


Key Points


* Nonparasitic benign hepatic cysts are usually asymptomatic. They become clinically evident due either to their enlarging size or the onset of complications such as infection or intracystic hemorrhage.


* Surgery is indicated for the management of symptomatic cysts. Laparoscopic surgery is an attractive option, given its low morbidity and rapid recovery.


* When the cyst is protruding from the surface of the liver, wide excision of the visible cyst wall is adequate. An intraparenchymal location of the majority of the cyst requires additional measures to obliterate the cavity, like omentopexy or cauterization of the secretory mucosa to prevent recurrence.

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