Surgical experience with nonparasitic cysts of the liver —The characteristics and constituents of cyst fluid—

Fifteen patients with nonparasitic hepatic cysts underwent surgery to relieve abdominal complaints, at the First Surgical Department, Tokyo University Hospital between 1966 and 1989. Total removal of the cyst was carried out in 14 of the patients, while puncture and aspiration only were performed in the other patient in whom a cyst had ruptured spontaneously, after which hemoperitoneum was observed at emergency laparotomy. The size of the cysts varied from 7–19 cm with a mean of 12.4 cm. Histological study revealed a congenital cyst in 14 patients and a cystadenoma in one. The epithelium lining of the internal surface of the congenital cysts was highly atrophic and desolated and often disappeared. Examination of the cyst fluid revealed the same concentration of electrolytes as in the serum. Hepatic enzyme levels were usually lower than in the serum, but lactic dehydrogenase and aminotransferase levels were elevated in a few cases. Tumor marker levels of the cyst fluid were higher than those in the serum in four of five patients examined.     

外科治疗非寄生虫性肝囊肿的选择策略

目的 探讨非寄生虫性肝囊肿外科治疗方法的选择策略及疗效.方法 回顾性分析上海市第六人民医院1995-2005年应用三种不同方法治疗284例非寄生虫性肝囊肿的临床资料.结果 囊肿穿刺抽液+注射无水乙醇161例:出现并发症9例(5.59%),复发53例(32.92%),病死率为0.开腹手术71例:出现并发症16例(22.54%),复发8例(11.27%),病死率2.82%.腹腔镜手术52例:出现并发症7例(13.46%),复发6例(11.54%),病死率为1.92%.结论 非寄生虫性肝囊肿外科治疗方式的选择,目前无统一标准.腹腔镜手术具有一定优势,但临床上应该根据病人的具体情况选择"个体化"的治疗方式.     

Comparative characteristics of nonparasitic and opisthorchiasis cysts of the liver

The authors observed 24 patients with opisthorchiasis and 14--with nonparasitic cysts of the liver. No essential differences in the tactics of surgical treatment of these cysts were noted. In medium-size and large cysts, the operative treatment--excision of cystic walls with omentoplasty, liver resection--is recommended; in small opisthorchiasis and nonparasitic cysts--dynamic observation with the performance of ultrasound scanning.     

Tailoring the management of nonparasitic liver cysts.

OBJECTIVE: To determine the optimal management of symptomatic non-parasitic liver cysts. SUMMARY BACKGROUND DATA: Management options for symptomatic nonparasitic liver cysts lack substantiation through comparative studies with respect to safety and long-term effectiveness. METHODS: A retrospective review of the surgical management of patients with hepatic cysts between October 1988 and August 1997 was undertaken to determine morbidity rates and to assess long-term recurrence. RESULTS: Thirty-eight patients (35 women, 3 men) underwent 48 operations for symptomatic hepatic cysts of mean diameter 12 cm, with a mean follow-up of 41 months. Twenty-three patients had simple cysts, and 15 patients had polycystic liver disease (PCLD). The symptomatic recurrence rates after laparoscopic or open deroofing for simple cysts were 8% and 29%, and for PCLD 71% and 20%, respectively. There were no symptomatic recurrences after 14 hepatic resections. There were no perisurgical deaths; however, morbidity rates were significant after laparoscopic deroofing, open deroofing, and hepatic resection (25%, 36%, and 50%, respectively). CONCLUSIONS: Selection of patients with truly symptomatic hepatic cysts is crucial before considering interventional techniques. For simple cysts, radical laparoscopic deroofing is usually curative; open deroofing should be reserved for cysts inaccessible by laparoscopy. The latter technique is well tolerated; however, long-term symptom control is unpredictable in patients with PCLD. Hepatic resection for PCLD provides satisfactory long-term symptom control but has an appreciable morbidity rate. Although laparoscopic and open deroofing procedures are less reliable in the long term for solitary cysts, they might be useful steps before embarking on this major procedure.     

Symptomatic nonparasitic cysts of the liver

A retrospective study of 14 patients who had symptomatic congenital liver cysts managed at the Department of Surgery, University of Hong Kong at Queen Mary Hospital together with a literature review was conducted to evaluate the current surgical practice for the condition. Seven patients were managed either expectantly (N=5) or by percutaneous aspiration (N=2). Surgery which included total cystectomy (N=3), external drainage (N=1), and marsupialization with (N=2) or without (N=1) fenestration was done for the remaining 7 patients, among whom 1 developed bleeding after total cystectomy. While percutaneous aspiration provides adequate symptomatic palliation in selected patients, eventual recurrent cyst formation is frequent, especially when the cyst exceeds 10 cm in diameter. Despite technological advances, the presence of biliary communication and malignancy could not be accurately determined preoperatively. Careful examination of the cyst cavity at surgery remains the most reliable guide. Drainage into the peritoneal cavity in the presence of infection or bile content provides satisfactory drainage with minimal morbidity and mortality. Since total cystectomy could be done safely without partial hepatectomy, it can even be considered in patients with deeply-seated lesions. The role of aggressive hepatic resection or liver transplantation for the management of liver cysts remains to be validated by further clinical evaluation.

---

Resumen Se efectuó un estudio restrospectivo de 14 pacientes con quistes congénitos y sintomáticos del hígado tratados en el Departamento de Cirugía de la Universidad de Hong Kong, Queen Mary Hospital; también se realizó una revisión de la literatura con el fin de evaluar el tratamiento actual de esta entidad. Siete pacientes fueron manejados en forma conservadora (N=5) o con aspiración percutánea (N=2). En los otros 7 pacientes se realizó cirugía, la cual incluyó cistectomía total (N=3), drenaje externo (N=1), y marsupialización con (N=2) o sin (N=1) fenestración; uno de ellos desarrolló sangrado despues de la cistectomía total. Aunque la aspiración percutánea provee adecuada paliación sintomática en pacientes seleccionados, la recurrencia del quiste es frecuente, especialmente cuando su diámetro es mayor de 10 cms. A pesar de los avances tecnológicos, la presencia de comunicación biliar y de malignidad no pudo ser certeramente determinada en la fase preoperatoria. El examen cuidadoso de la cavidad quística durante la cirugía sigue siendo el método más confiable. El drenaje a la cavidad peritoneal en presencia de infección o de contenido biliar, representa una modalidad de drenaje satisfactoria, con mínima morbilidad y mortalidad. Puesto que la cistectomía total puede ser realizada sin hepatectomía parcial, éste procedimiento puede ser considerado aún en pacientes con lesiones profundas. El papel de la resección hepática agresiva o el trasplante hepático en el manejo de los quistes del hígado deben ser validados mediante evaluación clínica adicional.

---

Résumé On a fait l'étude rétrospective de 14 patients ayant des kystes du foie congénitaux symptomatiques soignés dans le service de chirurgie à l'Hôpital Queen Mary de l'Université de Hong Kong en même temps que la revue de la littérature pour évaluer la pratique chirurgicale courante en la circonstance. On a traité 7 patients soit par l'expectative (N=5) soit par ponction et aspiration percutanées (N=2). On a également pratiqué une kystectomie totale (N=3), drainage externe (N=1), et marsupialisation avec (N=2) ou sans (N=1) fenestration chez les 7 autres patients dont un a fait une hémorrhagie après kystectomie totale. Tandis que la ponction et l'aspiration percutanées peuvent améliorer la Symptomatologie chez certains patients bien sélectionnés, la récidive est fréquente surtout quand le kyste dépasse 10 cm de diamètre. Malgré les progrès de la technique, on ne peut déterminer avec précision la présence de communication biliaire et de malignité avant l'opération. L'examen attentif de la cavité kystique à l'opération reste le guide le plus fiable. Le drainage de la cavité intrapéritoniale en cas d'infection ou de contenu biliaire constitue un geste satisfaisant avec morbidité et mortalité infimes. Comme la kystectomie totale peut être faite en toute sécurité sans nécessiter de hépatectomie partielle, on peut l'envisager même chez les patients ayant des lésions profondément situées. Il reste à préciser le rôle de la résection hépatique plus large ou même de la transplantation du foie pour le traitement des kystes du foie par une étude clinique plus poussée.

     

Surgical treatment of nonparasitic cysts of the liver: open versus laparoscopic treatment

Background

The aim of this study was to compare the immediately postoperative and follow-up results of open and laparoscopic surgery of hepatic cysts in a tertiary hepatobiliary referral center.

Materials and Methods

From March 1999 to February 2007, 59 patients underwent surgical treatment for nonparasitic liver cysts. Patients were assigned to the laparoscopic (n = 42) or open group (n = 17) for analysis.

Results

Three conversions to open procedures had to be performed in the laparoscopic group. One patient had to be reoperated because of a bile leakage in the laparoscopic group. Follow-up examination showed 2 recurrences in the laparoscopic and 3 in the open group. Three out of 17 patients in the open group had to be operated for incisional hernias. Time to previous activities was significantly shorter after laparoscopy.

Conclusions

Laparoscopic treatment of symptomatic nonparasitic liver cysts is superior concerning short- and long-term results in a vast majority of cases.     

Surgery of nonparasitic liver cysts

Under observation there were 24 patients with non-parasitic cysts of the liver. The cysts of the liver are frequently localized along the major or right portal fissures. According to indications, different surgical methods were used (resection of the liver, enucleation of the cysts, partial dissection of the cyst with tamponage of the cyst cavity by the omentum etc.). 22 patients operated upon recovered. Remote results were good.     

Simple surgical treatment of nonparasitic hepatic cysts.

Benign nonparasitic liver cysts are uncommon lesions. Incidental diagnosis is increasing with the advent of routine abdominal computed tomography and ultrasound scanning. Cysts that attain massive proportions often become symptomatic and require therapeutic intervention. Surgical resection and Roux-en-Y cystojejunostomy drainage have been the treatments of choice, but simpler unroofing techniques without drainage have recently been employed with success. Three patients with symptomatic, large, nonparasitic cysts were surgically treated in such a fashion without complication and form the basis of this report. The technique of wide unroofing involves excision of the nonhepatic cyst wall with oversewing of communicating biliary radicals. No recurrences have been detected in follow-up screening. Wide unroofing is a simple and yet reliable surgical option for the treatment of symptomatic hepatic cysts.     

非寄生虫性肝脏囊性疾病的诊断与治疗

随着影像学技术的飞速发展,非寄生虫性肝脏囊性疾病的临床诊断取得了巨大的进步,但对于某些疾病的鉴别诊断仍显不足.单纯多发肝囊肿与多囊肝病的鉴别诊断需结合家族遗传史、囊肿数目、是否合并多囊肾、有无分隔及B超检查特点;单纯单发肝囊肿与肝内胆管囊腺瘤的鉴别需结合影像学特点及活组织病理学检查结果.在治疗上,腹腔镜技术已广泛应用于肝脏囊性疾病的治疗,但并不能完全取代开腹手术,具体选择仍需依据患者的特点采取个体化、多样性的治疗手段.     

腹腔镜开窗引流术治疗儿童非寄生虫性脾囊肿的单中心经验

目的:探讨腹腔镜下开窗引流术治疗儿童非寄生虫性脾囊肿的应用价值。方法:回顾分析2017年5月至2020年5月为6例脾囊肿患儿行腹腔镜脾囊肿开窗引流术的临床资料,统计分析囊肿大小、患儿年龄、手术时间、术中出血量、腹腔引流管留置时间及术后住院时间等相关指标,并进行长期随访,观察复发及并发症等情况。结果:6例患儿均成功完成腹腔镜脾囊肿开窗引流术,无中转开腹。患儿4~15岁,手术时间75~150 min,术中出血量10~30 mL,术后留置腹腔引流管4~19 d,术后住院4~19 d。术后随访0.5~3年,2例复发。结论:腹腔镜下脾囊肿开窗引流术治疗儿童脾囊肿安全、可行,操作简单。     

Laparoscopic treatment of nonparasitic hepatic cysts

Background We present our experience with laparoscopic deroofing of nonparasitic hepatic cysts. Methods Laparoscopic deroofing was performed due to a solitary hepatic cyst in 21 patients and polycystic liver in four patients. Laparoscopy was indicated when a cyst was larger than 5 cm (the general size of cysts was 6.9 cm) and caused complaints and was in a superficial position. In eight patients in whom the cyst was larger than 10 cm, omentoplasty was performed. Results Intraoperative complications were not detected. Two conversions were performed because of the deep position of the cyst. Postoperative bile leakage was detected in one case that was treated conservatively. The average hospital stay was 4.7 days. Relapse occurred in two patients (8%), but only one of them required a second operation. Conclusions We recommend laparoscopic deroofing for treatment of nonparasitic liver cysts. This operation causes only slight discomfort for the patients, the intra- and postoperative morbidity is low, and relapses are rare.     

Laparoscopic management of symptomatic nonparasitic cysts of the liver. Indications and results.

OBJECTIVE: This clinical study evaluated the results of and defined the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse. SUMMARY BACKGROUND DATA: Different surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection, and liver transplantation. The advent of laparoscopic surgery has given new opportunities but, at the same time, has increased the uncertainties concerning the proper management of these patients. METHODS: Eight patients with solitary cysts and nine with polycystic liver and kidney disease (PLD) were seen during a period of 2 years. After a careful review of the symptoms, 6 patients were excluded from surgical treatment and 11 (4 solitary cysts and 7 PLD) were treated by laparoscopic fenestration. Postoperative morbidity and mortality rates, hospital stay, and clinical early and late results were evaluated. RESULTS: In the solitary cyst group, there was no surgical morbidity or deaths, and a complete regression of symptoms occurred in all patients. No recurrences were observed. In the PLD group, two patients had to be converted to laparotomic fenestration (28%). There were no deaths, and the surgical morbidity was limited to two cases of postoperative ascites. Symptomatic relief was obtained in 80% of patients, but the symptoms recurred in 60%. A subgroup of PLD at high risk for recurrence was identified. CONCLUSIONS: The best indications for laparoscopic fenestration seem to be solitary cyst and PLD characterized by large cysts mainly located on the liver surface (type 1), whereas PLD characterized by numerous small cysts all over the liver (type 2) should be considered a contraindication to laparoscopic fenestration.     

Open and laparoscopic treatment of nonparasitic splenic cysts

BACKGROUND: Nonparasitic splenic cysts are rare. Therefore, there is no 'evidence-based' information regarding their optimal surgical management. In the last years the laparoscopic approach has gained increasing acceptance in splenic surgery. The aim of this study is to present our experience with the laparoscopic management of splenic cysts. METHODS:The medical records of 7 patients with splenic cysts were reviewed retrospectively. RESULTS: One patient had an open partial splenic resection. Five patients, 3 of them with a posttraumatic and 2 with an epidermoid splenic cyst, underwent laparoscopic unroofing of the cyst. In 4 of these cases the postoperative course was uneventful, whereas in 1 case the patient developed a cyst relapse soon postoperatively. Later on this patient successfully underwent an open partial splenic resection. The 7th patient had an explorative laparoscopy. The cyst was located intrasplenically, entirely covered with unaffected splenic parenchyma, and reached the splenic hilus. Therefore, a conversion to open partial splenectomy was performed. CONCLUSION: Open partial splenectomy and laparoscopic cyst wall unroofing are both effective tools in the management of splenic nonparasitic cysts. Surgeons must master both techniques as nowadays spleen-preserving techniques should be attempted in every case of splenic nonparasitic cyst.     

Experience with different methods of treatment of nonparasitic liver cysts

BACKGROUND AND AIMS: In a search for the optimal management of nonparasitic liver cysts, a study was made of the effectiveness of different methods. PATIENTS AND METHODS: Between 1 January 1982 and 15 December 2001 we treated 132 patients with nonparasitic liver cysts. In 72 patients 31 cysts were treated with enucleation, 60 with deroofing, and 24 with stitching by laparotomy; two liver resections were also performed. In a further 34 patients 36 cysts were treated with deroofing by minimally invasive surgery. In an additional 26 patients 32 cysts were treated with various interventional radiological methods. RESULTS: There was no mortality. The morbidity rate after laparotomy was significant (22.2%). The rate of recurrence after enucleation and deroofing was 6.5% and 13.8%, respectively, but there were no recurrences after stitching and liver resection. The recurrence rate following laparoscopic deroofing was 19.4%, and that following interventional radiological procedures was 50%. CONCLUSIONS: Treatment is required only if cysts are highly symptomatic or if growth is detected. Interventional radiological methods do not prove more favorable than surgery. Laparoscopic fenestration is preferred because of its low morbidity and the short period of hospitalization. Traditional surgical methods should be reserved merely for cases in which laparoscopic deroofing is not feasible.     

Principles of treatment of nonparasitic cysts of the liver

A comparative investigation of different methods of treatment of nonparasitic cysts of the liver was carried out in 104 patients aged from 21 through 74 years with sizes of the cysts from 6 to 21 cm in diameter, divided into three groups. The first group included 50 patients who were subjected to open operations (segmentectomy, bisegmentectomy, fenestration of the cysts with treatment of the residual inner lining with ethanol, diathermocoagulation or cryodestruction). Laparoscopic fenestration and chemical or thermal treatment of the cysts were used in the second group of 29 patients, in the third group consisting of 25 patients a puncture-aspiration method was used under sonographic control. An analysis of the results showed advantages of laparoscopic and puncture methods that gave good immediate and long-term results, less number of postoperative complications and shorter periods of rehabilitation of the patients.