title: Analysis of unique liver volume restoration after laparoscopic fenestration of liver cysts.
abstract: BACKGROUND
  Laparoscopic fenestration is a standard procedure for the treatment of non-parasitic liver cysts. After fenestration, the remnant liver often restores its volume. However, no systematic analysis of the phenomenon exists. In the present study, the pattern of liver volume restoration after laparoscopic fenestration of liver cysts was analyzed, and the mechanism for the unique restoration was investigated.
  
  
  METHODS
  Seven patients with giant non-parasitic liver cysts underwent laparoscopic fenestration. Liver volume restoration in each section and changes in the diameter of the portal branch were analyzed after fenestration with CT or MRI. In two patients, regional liver volume restoration was assessed in detail using region-growing software, and change in portal flow distribution was estimated using computational fluid dynamics. Then, the regional liver volume restoration rate was compared with the portal hemodynamic changes.
  
  
  RESULTS
  Liver volume restoration after fenestration was dependent on the size and position of the cysts; it not uniform throughout the remnant liver. The liver volume restoration in sections that had been compressed by giant cysts was significantly greater than in other areas after fenestration. This volume restoration was accompanied by an increase in the diameters of the portal branches in these sections. In addition, a strong correlation between the regional liver volume restoration rate and the changes in portal flow distribution existed in the computationally analyzed cases.
  
  
  CONCLUSIONS
  Liver volume restoration after the fenestration of giant liver cysts non-uniformly occurs in the remnant liver. Improved portal vein circulation in the hepatic area adjacent to the excised giant liver cysts most likely regulates the greater regional volume restoration rate in the area.
authors: Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
authors: Yuji
authors: Y
authors: Iimuro
authors: Toshihiro
authors: T
authors: Okada
authors: Yuichi
authors: Y
authors: Kondo
authors: Kazuhiro
authors: K
authors: Suzumura
authors: Naoki
authors: N
authors: Uyama
authors: Yugo
authors: Y
authors: Uda
authors: Junichi
authors: J
authors: Yamanaka
authors: Jiro
authors: J
authors: Fujimoto
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D003560:Cysts / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D057446:Hydrodynamics; D007090:Image Interpretation, Computer-Assisted; D010535:Laparoscopy / Q000379:methods*; D008107:Liver Diseases / Q000601:surgery*; D008115:Liver Regeneration; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011169:Portal Vein; D012984:Software; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Computational flow dynamics; liver volume; portal vein circulation