Symptomatic nonparasitic cysts of the liver

• Published in: World journal of surgery 1990-07, Vol.14 (4), p.452-456
• Main Authors: Lai, Edward C. S., Wong, John
• Format: Article
• Language: English
• Subjects: Adult; Aged; Autres Patient; Biological and medical sciences; Cual; Cyst Cavity; Cysts - congenital; Cysts - epidemiology; Cysts - surgery; Drainage; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hong Kong - epidemiology; Humans; Inhalation; Liver Cyst; Liver Diseases - congenital; Liver Diseases - epidemiology; Liver Diseases - surgery; Male; Medical sciences; Middle Aged; Partial Hepatectomy
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/BF01658666

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. 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