NONPARASITIC CYSTS OF THE LIVER - RESULTS AND OPTIONS OF SURGICAL-TREATMENT

Nonparasitic cysts of the liver (NPHC) are highly variable in respect to appearance and therapeutic approach. The treatment of these cysts v aries according to the nature and appearance of the disease. Based on the variable nature of disease and the various therapeutic options, al l of which were attempted in our patients, the most suitable mode of t reatment fur different forms of NPHC are discussed. Ninety-one patient s with NPHC who had been treated surgically from 1977 through 1995 wer e examined retrospectively. Asymptomatic peripheral cysts measuring up to 10 cm do not require further treatment. Computed tomography (CT)-g uided aspiration (n = 9) should be regarded as a palliative measure. W ithin a short period, CT-guided aspiration led to recurrence of sympto ms in seven of our patients. Standard treatment of NPHC is fenestratio n with widest possible excision of the cystic wall, which can he perfo rmed laparoscopically (n = 10) or by the conventional surgical mode (n = 54). One patient was initially operated by the laparoscopic techniq ue but developed bleeding, which necessitated conversion to the open m ode. Three patients underwent synchronous laparoscopic cholecystectomy . Recurrence rates were similar: 11% in the laparoscopically treated g roup and 13% in the group that underwent conventional open surgery. Co nventional surgical treatment was always successful in cases of solita ry cysts. However, incases of multiple cysts measuring more than 5 cm, conventional surgery was followed by recurrence of symptoms in 26% of patients (7/27), who then had to undergo a second operation. Partial resection of the liver (n = 9) was successfully performed in cases of polycystic disease (n = 5) with concomitant enlargement of the organ a s well as in cases of large solitary cysts of the left lobe of the liv er (n = 4). In patients in whom we found that the cysts communicated w ith the ductal system (n = 3), we performed a cystojejunostomy to drai n the bile. The complication rate was low In addition to frequent post operative ascites, which necessitated no further intervention, we obse rved infectious complications in four patients. Twenty patients (22%) expired during a mean follow-up period of 6.2 years. Interestingly, de aths were frequently associated with malignancy (11/20). After fenestr ation of multiple cysts measuring > 5 cm, the patients are at high ris k for recurrence. Hence partial resection of the liver is an excellent therapeutic alternative in selected patients with polycystic disease and massive enlargement of the organ in whom the disease could not be controlled by simple fenestration. The results of this study show that laparoscopic fenestration should replace the conventional surgical te chnique as the gold standard in cases of NPHC because the laparoscopic technique is less stressful for the patient and is associated with a rate of success similar to that of the conventional technique.