The surgical management of congenital liver cysts - The need for a tailored approach with appropriate patient selection and proper surgical technique

Background: Most series that report the results of surgical treatment for c ongenital liver cysts focus more on the technical aspects of the operation than on the late outcome of these patients. In this paper, we emphasize the importance of appropriate patient selection and adequate surgical techniqu e for successful long-term outcome. Methods: Twenty-four consecutive patients with congenital liver cysts were selected for surgical treatment. According to our own classification, 13 pa tients had simple liver cysts, nine had multicystic liver disease, and two had type I polycystic liver disease. All of these patients were treated by the fenestration technique. An open approach was used for five patients (gr oup I) treated between 1984 and 1990. In 19 patients (group 2) treated sinc e 1991, a laparoscopic approach was used. The incidence of complicated live r cysts was 40% in group 1 and 68% in group 2. Results: There were no treatment-related deaths in this series. The mean po stoperative hospital stay was significantly shorter for patients who underw ent successful laparoscopic fenestration (p < 0.05). In the open group (rou p I), there were no postoperative complications, and all patients were aliv e and fi ee of symptoms during a mean follow-up of 130 months, without any sign of cyst recurrence, In the laparoscopic group (group 2), four patients were converted to open surgery. One of these patients had an inaccessible posterior cyst; another had bile within the cystic cavity, h further two ca ses had complicated liver cysts with an uncertain diagnosis between congeni tal and neoplastic cysts. Four patients (21%) developed peri- or postoperat ive complications. During a mean follow-up time of 38.5 months, none of the patients with simple liver cysts incurred late symptoms or signs of cyst r ecurrence. In the six patients with multicystic liver disease, one develope d disease-related cyst progression (17%) and required reoperation. One of t he two patients with type I polycystic liver disease (50%) developed asympt omatic disease-related cyst progression. Conclusions: When patients are carefully selected and a proper surgical tec hnique is employed, excellent long-term results with a low morbidity rate c an be achieved in patients with congenital liver cysts. Patients with multi cystic liver disease or type I polycystic liver disease are more prone to l ate cyst recurrence. A tailored approach is thus indicated for patients wit h congenital liver cystic disease. However, the laparoscopic approach appea rs to be the gold standard for the treatment of highly symptomatic or compl icated simple liver cysts.