The management of simple hepatic cysts: sclerotherapy or laparoscopic fenestration

Background: Prior to the era of laparoscopic surgery, open surgical deroofi ng was considered to be the most appropriate therapy for uncomplicated simp le hepatic cysts. Recently, there have been a number of reports of successf ul laparoscopic fenestration of simple hepatic cysts. Simple aspiration of these cysts is associated with a high recurrence rate. Cyst sclerosis with alcohol and, more recently, minocycline hydrochloride have been found to be effective in their management. So far there have been no trials comparing laparoscopic deroofing with sclerotherapy. A lack of consensus in their man agement results in considerable confusion and difficulty in deciding the op timum form of therapy. Methods: A systematic review of articles on the subject appearing in journa ls in the English language was conducted using the Medline database and by cross-referencing. Results and Conclusions: Both laparoscopic deroofing and cyst sclerosis hav e been found to be effective in partial or complete obliteration of the cys t and in the relief of symptoms produced by the cyst. It is essential to ru le out cystadenoma, malignancy, biliary communication and infection prior t o treating these cysts. Alcohol/minocycline based sclerotherapy has the adv antage of being associated with a lower incidence of complications. Surgery is indicated if it is difficult to rule out the above mentioned conditions , in the presence of biliary communication, in those cysts where sclerosis has been ineffective and in cases of recurrence. The choice between open an d laparoscopic surgery depends on the location of the cysts within the live r parenchyma.