Journal of Gastrointestinal Surgery

, Volume 12, Issue 3, pp 477–482

Laparoscopic Fenestration of Liver Cysts in Polycystic Liver Disease Results in a Median Volume Reduction of 12.5%

  • Loes van Keimpema
  • Jelle P. Ruurda
  • Miranda F. Ernst
  • Hendrikus J. A. A. van Geffen
  • Joost P. H. Drenth
Article

Abstract

Introduction

Patients with polycystic liver disease (PCLD) may develop symptoms due to increased liver volume. Laparoscopic fenestration is one of the options to reduce liver volume and to relieve symptoms. This study was performed to evaluate the safety and efficacy of laparoscopic liver cyst fenestration.

Patients and Methods

Twelve patients (all female, median age 45 years, range 35–58) with symptomatic PCLD were included between August 2005 and April 2007. Surgical data were recorded, liver volumes were measured on pre- and postoperative computed tomography (CT) scans, and patients completed a validated symptom-based questionnaire pre- and postoperatively.

Results

Median preoperative liver volume was 4,854 ml (range 1,606–8,201) and decreased to 4,153 ml postoperatively (range 1,556–8,232) resulting in median liver volume reduction of 12.5% (range +9.5 to −24.7%). Median procedural time was 123.5 min (range 50–318), and median hospitalization period was 3.5 days (range 1–8). Postoperative complications occurred in three patients including biliary leakage, obstruction of inferior vena cava and sepsis, all recovering with conservative management. Patients reported decreased symptoms of postprandial fullness and abdominal distension.

Conclusion

Laparoscopic fenestration in PCLD patients results in volume reduction of 12.5% and decrease of symptoms.

Keywords

Laparoscopic fenestration Polycystic liver disease Liver cyst 

References

  1. 1.
    Caremani M, Vincenti A, Benci A, Sassoli S, Tacconi D. Ecographic epidemiology of non-parasitic hepatic cysts. J Clin Ultrasound. 1993;21:115–118.PubMedCrossRefGoogle Scholar
  2. 2.
    Gaines PA, Sampson MA. The prevalence and characterization of simple hepatic cysts by ultrasound examination. Br J Radiol. 1989;62:335–337.PubMedCrossRefGoogle Scholar
  3. 3.
    Qian Q, Li A, King BF, Kamath PS, Lager DJ, Huston J III, Shub C, Davila S, Somlo S, Torres VE. Clinical profile of autosomal dominant polycystic liver disease. Hepatology. 2003;37:164–171.PubMedCrossRefGoogle Scholar
  4. 4.
    Davila S, Furu L, Gharavi AG, Tian X, Onoe T, Qian Q, Li A, Cai Y, Kamath PS, King BF, Azurmendi PJ, Tahvanainen P, Kaariainen H, Hockerstedt K, Devuyst O, Pirson Y, Martin RS, Lifton RP, Tahvanainen E, Torres VE, Somlo S. Mutations in SEC63 cause autosomal dominant polycystic liver disease. Nat Genet. 2004;36:575–577.PubMedCrossRefGoogle Scholar
  5. 5.
    Drenth JP, te Morsche RH, Smink R, Bonifacino JS, Jansen JB. Germline mutations in PRKCSH are associated with autosomal dominant polycystic liver disease. Nat Genet. 2003;33:345–347.PubMedCrossRefGoogle Scholar
  6. 6.
    Torres VE, Harris PC, Pirson Y. Autosomal dominant polycystic kidney disease. Lancet. 2007;369:1287–1301.PubMedCrossRefGoogle Scholar
  7. 7.
    Arnold HL, Harrison SA. New advances in evaluation and management of patients with polycystic liver disease. Am J Gastroenterol. 2005;100:2569–2582.PubMedCrossRefGoogle Scholar
  8. 8.
    Everson GT, Taylor MR, Doctor RB. Polycystic disease of the liver. Hepatology. 2004;40:774–782.PubMedGoogle Scholar
  9. 9.
    Szabo LS, Takacs I, Arkosy P, Sapy P, Szentkereszty Z. Laparoscopic treatment of nonparasitic hepatic cysts. Surg Endosc. 2006;20:595–597.PubMedCrossRefGoogle Scholar
  10. 10.
    Lin TY, Chen CC, Wang SM. Treatment of non-parasitic cystic disease of the liver: a new approach to therapy with polycystic liver. Ann Surg. 1968;168:921–927.PubMedCrossRefGoogle Scholar
  11. 11.
    Gigot JF, Jadoul P, Que F, Van Beers BE, Etienne J, Horsmans Y, Collard A, Geubel A, Pringot J, Kestens PJ. Adult polycystic liver disease: is fenestration the most adequate operation for long-term management? Ann Surg. 1997;225:286–294.PubMedCrossRefGoogle Scholar
  12. 12.
    Paterson-Brown S, Garden OJ. Laser-assisted laparoscopic excision of liver cyst. Br J Surg. 1991;78:1047.PubMedCrossRefGoogle Scholar
  13. 13.
    Z’graggen K, Metzger A, Klaiber C. Symptomatic simple cysts of the liver: treatment by laparoscopic surgery. Surg Endosc. 1991;5:224–225.PubMedCrossRefGoogle Scholar
  14. 14.
    Fiamingo P, Tedeschi U, Veroux M, Cillo U, Brolese A, Da RA, Madia C, Zanus G, D’Amico DF. Laparoscopic treatment of simple hepatic cysts and polycystic liver disease. Surg Endosc. 2003;17:623–626.PubMedCrossRefGoogle Scholar
  15. 15.
    Gloor B, Ly Q, Candinas D. Role of laparoscopy in hepatic cyst surgery. Dig Surg. 2002;19:494–499.PubMedCrossRefGoogle Scholar
  16. 16.
    Burpee SE, Kurian M, Murakame Y, Benevides S, Gagner M. The metabolic and immune response to laparoscopic versus open liver resection. Surg Endosc. 2002;16:899–904.PubMedCrossRefGoogle Scholar
  17. 17.
    Bovenschen HJ, Janssen MJ, van Oijen MG, Laheij RJ, van Rossum LG, Jansen JB. Evaluation of a gastrointestinal symptoms questionnaire. Dig Dis Sci. 2006;51:1509–1515.PubMedCrossRefGoogle Scholar
  18. 18.
    Emiroglu R, Coskun M, Yilmaz U, Sevmis S, Ozcay F, Haberal M. Safety of multidetector computed tomography in calculating liver volume for living-donor liver transplantation. Transplant Proc. 2006;38:3576–3578.PubMedCrossRefGoogle Scholar
  19. 19.
    Radtke A, Sotiropoulos GC, Nadalin S, Molmenti EP, Schroeder T, Lang H, Saner F, Valentin-Gamazo C, Frilling A, Schenk A, Broelsch CE, Malago M. Preoperative volume prediction in adult living donor liver transplantation: how much can we rely on it? Am J Transplant. 2007;7:672–679.PubMedCrossRefGoogle Scholar
  20. 20.
    Sandrasegaran K, Kwo PW, DiGirolamo D, Stockberger SM Jr., Cummings OW, Kopecky KK. Measurement of liver volume using spiral CT and the curved line and cubic spline algorithms: reproducibility and interobserver variation. Abdom Imaging. 1999;24:61–65.PubMedCrossRefGoogle Scholar
  21. 21.
    Garcea G, Pattenden CJ, Stephenson J, Dennison AR, Berry DP. Nine-year single-center experience with nonparastic liver cysts: diagnosis and management. Dig Dis Sci. 2007;52:185–191.PubMedCrossRefGoogle Scholar
  22. 22.
    Gigot JF, Legrand M, Hubens G, de CL, Wibin E, Deweer F, Druart ML, Bertrand C, Devriendt H, Droissart R, Tugilimana M, Hauters P, Vereecken L. Laparoscopic treatment of nonparasitic liver cysts: adequate selection of patients and surgical technique. World J Surg. 1996;20:556–561.PubMedCrossRefGoogle Scholar
  23. 23.
    Giuliante F, D’Acapito F, Vellone M, Giovannini I, Nuzzo G. Risk for laparoscopic fenestration of liver cysts. Surg Endosc. 2003;17:1735–1738.PubMedCrossRefGoogle Scholar
  24. 24.
    Kabbej M, Sauvanet A, Chauveau D, Farges O, Belghiti J. Laparoscopic fenestration in polycystic liver disease. Br J Surg. 1996;83:1697–1701.PubMedCrossRefGoogle Scholar
  25. 25.
    Katkhouda N, Hurwitz M, Gugenheim J, Mavor E, Mason RJ, Waldrep DJ, Rivera RT, Chandra M, Campos GM, Offerman S, Trussler A, Fabiani P, Mouiel J. Laparoscopic management of benign solid and cystic lesions of the liver. Ann Surg. 1999;229:460–466.PubMedCrossRefGoogle Scholar
  26. 26.
    Konstadoulakis MM, Gomatos IP, Albanopoulos K, Alexakis N, Leandros E. Laparoscopic fenestration for the treatment of patients with severe adult polycystic liver disease. Am J Surg. 2005;189:71–75.PubMedCrossRefGoogle Scholar
  27. 27.
    Kornprat P, Cerwenka H, Bacher H, El-Shabrawi A, Tillich M, Langner C, Mischinger HJ. Surgical therapy options in polycystic liver disease. Wien Klin Wochenschr. 2005;117:215–218.PubMedCrossRefGoogle Scholar
  28. 28.
    Martin IJ, McKinley AJ, Currie EJ, Holmes P, Garden OJ. Tailoring the management of nonparasitic liver cysts. Ann Surg. 1998;228:167–172.PubMedCrossRefGoogle Scholar
  29. 29.
    Morino M, De GM, Festa V, Garrone C. Laparoscopic management of symptomatic nonparasitic cysts of the liver. Indications and results. Ann Surg. 1994;219:157–164.PubMedCrossRefGoogle Scholar
  30. 30.
    Robinson TN, Stiegmann GV, Everson GT. Laparoscopic palliation of polycystic liver disease. Surg Endosc. 2005;19:130–132.PubMedCrossRefGoogle Scholar
  31. 31.
    Moorthy K, Mihssin N, Houghton PW. The management of simple hepatic cysts: sclerotherapy or laparoscopic fenestration. Ann R Coll Surg Engl. 2001;83:409–414.PubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Loes van Keimpema
    • 1
  • Jelle P. Ruurda
    • 2
  • Miranda F. Ernst
    • 2
  • Hendrikus J. A. A. van Geffen
    • 2
  • Joost P. H. Drenth
    • 1
  1. 1.Department of Medicine, Division of Gastroenterology and HepatologyUniversity Medical Center St. RadboudNijmegenThe Netherlands
  2. 2.Department of SurgeryJeroen Bosch Hospital’s HertogenboschThe Netherlands

Personalised recommendations