TAILORING THE MANAGEMENT OF NONPARASITIC LIVER CYSTS

Objective To determine the optimal management of symptomatic non-paras itic liver cysts. Summary Background Data Management options for sympt omatic nonparasitic liver cysts lack substantiation through comparativ e studies with respect to safety and long-term effectiveness. Methods A retrospective review of the surgical management of patients with hep atic cysts between October 1988 and August 1997 was undertaken to dete rmine morbidity rates and to assess long-term recurrence. Results Thir ty-eight patients (35 women, 3 men) underwent 48 operations for sympto matic hepatic cysts of mean diameter 12 cm, with a mean follow-up of 4 1 months. Twenty-three patients had simple cysts, and 15 patients had polycystic liver disease (PCLD). The symptomatic recurrence rates afte r laparoscopic or open deroofing for simple cysts were 8% and 29%, and for PCLD 71% and 20%, respectively. There were no symptomatic recurre nces after 14 hepatic resections. There were no perisurgical deaths; h owever, morbidity rates were significant after laparoscopic deroofing, open deroofing, and hepatic resection (25%, 36%, and 50%, respectivel y). Conclusions Selection of patients with truly symptomatic hepatic c ysts is crucial before considering interventional techniques. For simp le cysts, radical laparoscopic deroofing is usually curative; open der oofing should be reserved for cysts inaccessible by laparoscopy. The l atter technique is well tolerated; however, long-term symptom control is unpredictable in patients with PCLD. Hepatic resection for PCLD pro vides satisfactory long-term symptom control but has an appreciable mo rbidity rate. Although laparoscopic and open deroofing procedures are less reliable in the long term for solitary cysts, they might be usefu l steps before embarking on this major procedure.