Does laparoscopic fenestration provide long-term alleviation for symptomatic cystic disease of the liver?
BACKGROUND
The use of laparoscopic technique for management of symptomatic liver cysts is documented to be a feasible and safe procedure with good short-term symptomatic relief. However, it cannot be recommended as the standard of care as long-term results are scarce. The present study was initiated to review the long-term results of this approach in the management of symptomatic liver cysts.


METHODS
A retrospective review of all patients with symptomatic liver cysts that were treated by laparoscopic fenestration in our department over an 8-year period from 1993 to 2001. The clinical and radiographical data were analysed at follow-up to assess the -outcome.


RESULTS
Eleven patients were treated using a laparoscopic approach; 10 patients with solitary cysts and one with adult polycystic liver disease. All patients achieved short-term alleviation of symptoms and an uneventful postoperative course. The mean hospital stay was 3 days. Long-term follow up was available for 9 patients with a mean of 44 months. Histologically, one of the patients was diagnosed with a biliary cystadenoma and she had a symptomatic recurrence and a liver resection at 20 months. In the other seven patients, there was no clinical recurrence but a radiographical recurrence of 28.5%. The patient with adult polycystic liver disease had two symptomatic recurrences: at 26 months where he underwent a repeat laparoscopic fenestration and at 43 months where he underwent an open fenestration.


CONCLUSIONS
The present study confirms that with adequate patients election, long-term alleviation of symptoms can be achieved with the laparoscopic approach for solitary simple liver cysts but not for polycystic liver disease or cystic tumours of the liver.
Tan
Y M
YM
Department of Surgery, Singapore General Hospital, Singapore.
Ooi
London Lucien
LL
Soo
K C
KC
Mack
P O P
PO
D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery; D003537:Cystadenoma / Q000601:surgery; D003560:Cysts / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome