LAPAROSCOPIC FENESTRATION IN THE MANAGEME NT OF SYMPTOMATIC POLYCYSTIC LIVER-DISEASE

We report the case of a 70-year-old woman with polycystic disease of t he liver and kidney, complicated with rupture and hemorrhage of the he patic cysts located in the right lobe. A laparoscopic approach was use d. After identifying the polycystic mass, the cytologic examination of the aspirated hematic fluid and the intraoperative biopsy showed its benign nature. An hepatic fenestration was performed. Hemostasis was a chieved by electrosurgical and argon probes. The postoperative course was satisfactory and radiological improvement was demonstrated on the CT scan 3 months later. Follow-up examination one year later has been uneventful. Fenestration is one of the less stressing surgical options in the adult polycystic liver disease when treatment is indicated. Th e laparoscopic approach may be used with safety to perform a similar t echnique in selected cases, establishing a communication between the c ysts and the peritoneal cavity. Nevertheless, it may be difficult to r each deeply situated cysts and to differentiate them from vascular str uctures. Laparoscopic intraoperative ultrasonography might be of great value in these cases. Likewise, long term studies are needed to deter mine the benefits and the indications of the laparoscopic fenestration .