Non parasitic cysts of the liver: Laparoscopic treatment and long-term results [Cisti non parassitarie del fegato: trattamento laparoscopico e risultati a lungo termine]

In the current debate on the indications for the laparoscopic treatment of symptomatic simple hepatic cysts, we emphasize the importance of the exact indications, practicing in an area endemic for hepatic hydatidosis. 8 years ago we started treating laparoscopically the simple hepatic cysts and the polycystosis. Although the laparoscopic approach to parasitic hepatic cysts has been recently introduced, this method has to be the result of a conscious choice and with a presumptive diagnosis to support it. In fact, reviewing the literature on the subject, we realized how most of the intraoperative complications were due to an erroneous preoperative diagnosis, likely to be attributed to the infrequent observation of hepatic hydatid disease. Hence, it seems of primary importance to review the subject in light of the potential dangerous aspect of the laparoscopic approach.METHODS:From 1992 to 2000 we treated 38 cases of benign liver cystic disease (29 echinococcal cysts, 8 symptomatic simple cysts, 1 polycystosis). Due to the endemic nature of the disease in our territory, the preoperative diagnosis was very meticulous (ultrasonography, CT scan, MRI, serology...). Only 9 cases with a preoperative diagnosis of simple cyst or polycystosis were treated with laparoscopic wide fenestration, combined with cholecystectomy in three cases. The follow-up consisted of ultrasonography in the majority of cases and CT scan in 2.RESULTS:All the 9 laparoscopic cases were uncomplicated and no conversions to open procedures have been recorded. The final pathology confirmed the initial diagnosis in all cases. The follow-up ranged between 1 and 8 years and complete remission has been obtained.CONCLUSIONS:The results of this study demonstrate how a meticulous preoperative clinical evaluation can avoid intraoperative complications, making the laparoscopic approach to non-hydatid hepatic cystic disease safe and efficacious. Although laparoscopy is indicated in parasitic liver pathology, the technical approach is very different from the simple cystic disease. In the former, in fact, hepatic resection or pericystectomy are utilized, the results of which have been currently evaluated and compared with the open technique on a large scale on several ongoing trials.