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. 2009 May;11(3):235-41.
doi: 10.1111/j.1477-2574.2009.00042.x.

Surgical management and longterm follow-up of non-parasitic hepatic cysts

Tamara M H Gall  1 , Gabriel C Oniscu, Krishnakumar Madhavan, Rowan W Parks, O James Garden
Affiliations

Surgical management and longterm follow-up of non-parasitic hepatic cysts

Tamara M H Gall et al. HPB (Oxford). 2009 May.

Abstract

Background: Despite the increasing use of laparoscopic techniques, the optimal surgical approach for cystic liver disease has not been well defined. This study aims to determine the optimum operative approach for these patients.

Methods: Data were identified from the Lothian Surgical Audit, case note review and general practitioner contact. Patients were contacted and asked to complete the SF-36 questionnaire on quality of life.

Results: A total of 102 patients (67 with simple cysts, 31 with polycystic liver disease [PCLD], four with cystic tumours) underwent 62 laparoscopic deroofings, 15 open deroofings, 36 resections and one liver transplant between June 1985 and April 2006. The median follow-up was 77 months (range 3-250 months). Morbidity and recurrent symptom rates after laparoscopic surgery were greater in PCLD patients compared with simple cyst patients, at 31% (four patients) vs. 15% (seven patients) and 85% (11 patients) vs. 29% (24 patients), respectively. Four patients with simple cysts and eight with PCLD required further surgery. All patients with simple cysts had comparable quality of life after surgery. Patients with recurrent symptoms after surgery for PCLD had a significantly better quality of life following laparoscopic deroofing than after resection.

Conclusions: Most simple cysts can be managed laparoscopically, but there is a definite role for open resection in some patients. Open deroofing is the preferred approach for a dominant cyst pattern in PCLD, whereas resection is necessary for diffuse cystic disease.

Keywords: hepatic; laparoscopy; liver cyst; liver resection.

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Figures

Figure 1
Figure 1
Quality of life scores following surgery for (A) simple cysts and (B) polycystic liver disease
Figure 2
Figure 2
Management algorithm for non-parasitic liver cysts
See this image and copyright information in PMC

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