Skip to main content
SpringerLink
Log in

The surgical management of congenital liver cysts

The need for a tailored approach with appropriate patient selection and proper surgical technique

  • Original Articles
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Most series that report the results of surgical treatment for congenital liver cysts focus more on the technical aspects of the operation than on the late outcome of these patients. In this paper, we emphasize the importance of appropriate patient selection and adequate surgical technique for successful long-term outcome.

Methods

Twenty-four consecutive patients with congenital liver cysts were selected for surgical treatment. According to our own classification, 13 patients had simple liver cysts, nine had multicystic liver disease, and two had type I polycystic liver disease. All of these patients were treated by the fenestration technique. An open approach was used for five patients (group 1) treated between 1984 and 1990. In 19 patients (group 2) treated since 1991, a laparoscopic approach was used. The incidence of complicated liver cysts was 40% in group 1 and 68% in group 2.

Results

There were no treatment-related deaths in this series. The mean postoperative hospital stay was significantly shorter for patients who underwent successful laparoscopic fenestration (p < 0.05). In the open group (group 1), there were no postoperative complications, and all patients were alive and free of symptoms during a mean follow-up of 130 months, without any sign of cyst recurrence. In the laparoscopic group (group 2), four patients were converted to open surgery. One of these patients had an inaccessible posterior cyst; another had bile within the cystic cavity. A further two cases had complicated liver cysts with an uncertain diagnosis between congenital and neoplastic cysts. Four patients (21%) developed peri- or postoperative complications. During a mean follow-up time of 38.5 months, none of the patients with simple liver cysts incurred late symptoms or signs of cyst recurrence. In the six patients with multicystic liver disease, one developed disease-related cyst progression (17%) and required reoperation. One of the two patients with type I polycystic liver disease (50%) developed asymptomatic disease-related cyst progression.

Conclusions

When patients are carefully selected and a proper surgical technique is employed, excellent long-term results with a low morbidity rate can be achieved in patients with congenital liver cysts. Patients with multicystic liver disease or type I polycystic liver disease are more prone to late cyst recurrence. A tailored approach is thus indicated for patients with congenital liver cystic disease. However, the laparoscopic approach appears to be the gold standard for the treatment of highly symptomatic or complicated simple liver cysts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Society of Anesthesiologists [ASA] New classification of physical status. Anesthesiology 24: 111

  2. Akwari OE, Tucker A, Seigler HF, Itani KMF (1990) Hepatobiliary cystadenoma with mesenchymal stroma. Ann Surg 211: 18–27

    Article  PubMed  CAS  Google Scholar 

  3. Barnes PA, Thomas JL, Bernardino ME (1981) Pitfalls in the diagnosis of hepatic cysts by computed tomography. Radiology 141: 129–133

    PubMed  CAS  Google Scholar 

  4. Bruneton JN, Eresue J, Caramella E, Drouillard J, Roux P, Fenart D (1983) Les kystes congénitaux du foie en échographie. J Radio 64: 471–476

    CAS  Google Scholar 

  5. Couinaud C (1957) Le foie: études anatomiques et chirurgicales. Masson, Paris, pp

    Google Scholar 

  6. Diez J, Decoud J, Gutierrez L, Suhl A, Merello J (1998) Laparoscopic treatment of symptomatic cysts of the liver. Br J Surg 85: 25–27

    Article  PubMed  CAS  Google Scholar 

  7. Edwards JD, Eckhauser FE, Knol JA, Strodel WE, Appelman HD (1987) Optimizing surgical management of symptomatic solitary hepatic cysts. Am Surg 53: 510–514

    PubMed  CAS  Google Scholar 

  8. Gigot JF, Jadoul P, Que F, Van Beers BE, Etienne J, Horsmans Y, Collard A, Geubel A, Pringot J, Kestens PJ (1997) Adult polycystic liver disease: is fenestration the most adequate operation for long-term management? Ann Surg 225: 286–294

    Article  PubMed  CAS  Google Scholar 

  9. Gigot JF, Legrand M, Hubens G, de Canniere L, Wibin E, Deweer F, Druart ML, Bertrand C, Devriendt H, Droissart C, Tugilimana M, Hauters P, Vereecken L (1996) Laparoscopic treatment of nonparasitic liver cysts: adequate selection of patients and surgical technique. World J Surg 20: 556–561

    Article  PubMed  CAS  Google Scholar 

  10. Heintz A, Junginger T (1998) Nicht-parasitäre leberzysten: laparoskopische und konventionelle entdachtung. Zentralbl Chir 123: 136–139

    PubMed  CAS  Google Scholar 

  11. Horsmans Y, Laka A, Gigot JF, Geubel AP (1996) Serum and cyst fluid CA 19.9 determinations as a diagnostic help in liver cysts of uncertain nature. Liver 16: 255–257

    PubMed  CAS  Google Scholar 

  12. Horsmans Y, Laka A, Van Beers BE, Descamps C, Gigot JF, Geubel AP (1997) Hepatobiliary cystadenocarcinoma without ovarian stroma and normal CA 19.9 levels: unusually prolonged evolution. Dig Dis Sci 42: 1406–1408

    Article  PubMed  CAS  Google Scholar 

  13. Ishak KG, Willis GW, Cummins SD, Bullock AA (1977) Biliary cyst-adenoma and cystadenocarcinoma: report of 14 cases and review of the literature. Cancer 38: 322–338

    Article  Google Scholar 

  14. Kabbej M, Sauvanet A, Chauveau D, Farges O, Belghiti J (1996) Laparoscopic fenestration in polycystic liver disease. Br J Surg 83: 1697–1701

    Article  PubMed  CAS  Google Scholar 

  15. Katkhouda N, Hurwitz M, Gugenheim J, Mavor E, Mason RJ, Waldrep DJ, Rivera RT, Chandra M, Campos G, Offerman S, Trussler A, Fabiani P, Mouiel J (1999) Laparoscopic management of benign solid and cystic lesions of the liver. Ann Surg 229: 460–466

    Article  PubMed  CAS  Google Scholar 

  16. Khoury G, Abiad F, Geagea T, Nabout G, Jabbour S (2000) Laparoscopic treatment of hydatid cysts of the liver and spleen. Surg Endosc 14: 243–245

    Article  PubMed  CAS  Google Scholar 

  17. Korobkin M, Stephens DH, Lee KKT, Stanley RJ, Fishman EK, Francis IR, Alpern MB, Rynties M (1989) Biliary cystadenoma: CT and sonographic findings. Am J Radiol 153: 507–511

    CAS  Google Scholar 

  18. Krahenbuhl L, Baer HV, Renzulli P, Z’Graggen K, Frei E, Buchler MW (1996) Laparoscopic management of nonparasitic symptom-producing solitary hepatic cysts. J Am Coll Surg 183: 493–498

    PubMed  CAS  Google Scholar 

  19. Kunstlinger F (1983) Découverte échographique fortuite de lésions focalisées du foie. Gastroenterol Clin Biol 7: 951–954

    PubMed  CAS  Google Scholar 

  20. Lai ECS, Wong J (1990) Symptomatic nonparasitic cysts of the liver. World J Surg 14: 452–456

    Article  PubMed  CAS  Google Scholar 

  21. Lange V, Meyer G, Rau H, Schildberg FW (1992) Minimal-invasive eingriffe bei solitären lebercysten. Chirurg 63: 349–352

    PubMed  CAS  Google Scholar 

  22. Lin TY, Chen CC, Wang SM (1968) Treatment of non-parasitic cystic disease of the liver: a new approach to therapy with polycystic liver. Ann Surg 168: 921–927

    Article  PubMed  CAS  Google Scholar 

  23. Litwin DEM, Taylor BR, Greig P, Langer B (1987) Nonparasitic cysts of the liver: the case for conservative surgical management. Ann Surg 205: 45–48

    Article  PubMed  CAS  Google Scholar 

  24. Martin IJ, McKinley AJ, Currie EJ, Holmes P, Garden OJ (1998) Tailoring the management of nonparasitic liver cysts. Ann Surg 228: 167–172

    Article  PubMed  CAS  Google Scholar 

  25. Marvik R, Myrvold HE, Johnsen G, Rysland P (1993) Laparoscopic ultrasonography and treatment of hepatic cysts. Surg Laparosc Endosc 3: 172–174

    PubMed  CAS  Google Scholar 

  26. Montorsi M, Torzilli G, Fumagalli U, Bona S, Rosati R, De Simone M, Rovati V, Mosca F, Filice C (1994) Percutaneous alcohol sclerotherapy of simple hepatic cysts: results from a multicentre survey in Italy. Hepatobil Surg 8: 89–94

    CAS  Google Scholar 

  27. Morino M, De Guili M, Festa V, Garrone C (1994) Laparoscopic management of symptomatic nonparasitic cysts of the liver: indications and results. Ann Surg 219: 157–164

    Article  PubMed  CAS  Google Scholar 

  28. Paterson-Brown S, Garden OJ (1991) Laser-assisted laparoscopic excision of liver cyst. Br J Surg 78: 1047

    Article  PubMed  CAS  Google Scholar 

  29. Payatakes AH, Kakkos SK, Solomou EG, Tepetes KN, Karavias DD (1999) Surgical treatment of non-parasitic hepatic cysts: report of 12 cases. Eur J Surg 165: 1154–1158

    Article  PubMed  CAS  Google Scholar 

  30. Pinto MM, Kaye AD (1989) Fine needle aspiration of cystic liver lesions: cytologic examination and carcinoembryonic antigen asay of cyst contents. Acta Cytol 33: 852–856

    PubMed  CAS  Google Scholar 

  31. Roemer CE, Ferrucci Jr JT, Mueller PR, Simeone JF, Vansonnenberg E, Wittenberg J (1981) Hepatic cysts: diagnosis and therapy by sonographic needle aspiration. Am J Roentgenol 136: 1065–1070

    CAS  Google Scholar 

  32. Sanfelippo PM, Beahrs OH, Weiland LH (1974) Cystic disease of the liver. Ann Surg 179: 922–925

    Article  PubMed  CAS  Google Scholar 

  33. Tikkakoski T, Makela JR, Leinonen S, Paivansalo M, Merikanto J, Karttunen A, Siniluoto T, Kairaluoma MI (1996) Treatment of symptomatic congenital hepatic cysts with single-session percutaneous drainage and ethanol sclerosis: technique and outcome. JVIR 7: 235–239

    PubMed  CAS  Google Scholar 

  34. Van Sonnenberg E, Wroblicka JT, D’Agostino HB, Mathieson JRM, Casola G, O’Laoide R, Cooperberg PL (1994) Symptomatic hepatic cysts: percutaneous drainage and sclerosis. Radiology 190: 387–392

    Google Scholar 

  35. Vogl S, Koperna T, Satzinger U, Schulz F (1995) Nicht-parastäre leberzysten. Langenbecks Arch Chir 380: 340–344

    Article  PubMed  CAS  Google Scholar 

  36. Vuillemin-Bodaghi V, Zins M, Vullierme MP, Denys A, Sibert A, Vilgrain V, Belghiti J, Meny Y (1997) Imagerie des kystes atypiques du foie: étude de 26 lésions opérées. Gastroenterol Clin Biol 21: 394–399

    PubMed  CAS  Google Scholar 

  37. Wellwood JM, Madara JL, Cady B, Haggitt RC (1978) Large intrahepatic cysts and pseudocysts: pitfalls in diagnosis and treatment. Am J Surg 135: 57–64

    Article  PubMed  CAS  Google Scholar 

  38. Wheeler DA, Edmondson HA (1985) Cystadenoma with mesenchymal stoma (CMS) in the liver and bile ducts: a clinicopathologic study of 17 cases, 4 with malignant change. Cancer 56: 1434–1445

    Article  PubMed  CAS  Google Scholar 

  39. Zacherl J, Scheuba C, Imhof M, Jakesz R, Fugger R (2000) Long-term results after laparoscopic unroofing of solitary symptomatic congenital liver cysts. Surg Endosc 14: 59–62

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Saint-Luc University Hospital, Université Catholique de Louvain (UCL), Hippocrate Avenue, 10, B-1200, Brussels, Belgium

    J. -F. Gigot, S. Metairie, J. Etienne, D. Glineur & P. Gianello

  2. Department of Gastroenterology, Saint-Luc University Hospital, Université Catholique de Louvain (UCL), Hippocrate Avenue, 10, B-1200, Brussels, Belgium

    Y. Horsmans, R. Materne & A. Geubel

  3. Department of Medical Imaging, Saint-Luc University Hospital, Université Catholique de Louvain (UCL), Hippocrate Avenue, 10, B-1200, Brussels, Belgium

    B. E. van Beers & P. Deprez

  4. Department of Pathology, Saint-Luc University Hospital, Université Catholique de Louvain (UCL), Hippocrate Avenue, 10, B-1200, Brussels, Belgium

    C. Sempoux

Authors
  1. J. -F. Gigot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Metairie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Etienne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y. Horsmans
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. E. van Beers
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Sempoux
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Deprez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R. Materne
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Geubel
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. D. Glineur
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. P. Gianello
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Online publication: 13 March 2001

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gigot, J.F., Metairie, S., Etienne, J. et al. The surgical management of congenital liver cysts. Surg Endosc 15, 357–363 (2001). https://doi.org/10.1007/s004640090027

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s004640090027

Key words

Search

Navigation