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Liver Cysts

Up to 5% of the population have one or more liver cysts, with a sharp rise in incidence with age. The vast majority are thought to arise as a congenital aberration of bile duct development and are termed simple cysts. The dominant cyst is usually accompanied by several other small cysts within the liver. Polycystic liver disease (PCLD) is presumed to exist when the whole organ is involved; it appears to be genetically derived and to have a close association with polycystic kidney disease. Such benign cysts require differentiation from parasitic cysts, which are usually the result of Echinococcus infection, and neoplastic lesions, which may be multiple, cist

Hepatic cysts are normally asymptomatic and detected incidentally during abdominal imaging. Symptomatic patients with significant pain tend to have large cysts, which may be complicated by

Recent literature in this area focuses on minimally invasive treatment in the form of percutaneous sclerosant therapy and laparoscopic deroofing of the cyst wall. Although the early results of both techniques are promising, there is a

METHODS AND SURGICAL TECHNIQUES

Retrospective review of discharge summaries and surgical records revealed 38 patients who underwent surgery for a histologically proven nonparasitic liver cyst at the Royal Infirmary of Edinburgh from October 1988 to July 2002. The patients' age; sex; presurgical symptoms; serum levels of hemoglobin, sodium, potassium, urea, creatinine, and

All symptomatic patients were considered for extensive deroofing of cysts at open surgery, but from 1991 patients with dominant cysts were considered for laparoscopic deroofing. The principles of laparoscopic and open deroofing were to remove as much of the cyst roof as possible by dividing tissue at the common cyst-liver boundary. At

Hepatic resection was undertaken in patients with multiple, diffuse liver involvement or recurrence after open or laparoscopic deroofing (Fig. 2) . Hepatic resection was undertaken through a bilateral "rooftop" incision using conventional techniques, minimizing blood loss by preliminary dissection of the portal and arterial inflow. Resection of liver parenchyma and open deroofing of associated liver cysts in the residual liver were undertaken using a resection was undertaken in patients with multiple, diffuse liver involvement or recurrence after open or laparoscopic deroofing (Fig. 2) . Hepatic resection was undertaken through a bilateral "rooftop" incision using conventional techniques, minimizing blood loss by preliminary dissection of the portal and arterial inflow. Resection of liver parenchyma and open deroofing of associated liver cysts in the residual liver were undertaken using a

Symptoms and Presurgical Investigations

Surgical Treatment

The total number and type of surgical procedures performed, surgical time, blood loss, postsurgical stay, and morbidity rate according to cyst morphology are shown in Table 2 . Four patients with simple cysts underwent

Our experience supports the previous observation that symptomatic hepatic cysts occur 10 times more commonly in women, usually at age 50 to 60 years, with pain as the predominant symptom. Although it is easy to attribute patient symptoms to the presence of a large hepatic cyst, the possibility of coexisting pathology must be excluded liver

Despite improved imaging techniques, the presence of neoplasia is still difficult to determine before and during surgery. Our experience reveals that surgical ultrasound commonly detects internal acoustic shadows within these

Percutaneous aspiration of symptomatic hepatic cysts is a simple option, but recurrence is invariable. Guglieli et al. also noted the development of recurrent symptoms in all 20 patients with simple cysts within 2 years after aspiration. There is also a significant risk of introducing infection, which may be life-threatening. The technique may be best reserved as a diagnostic procedure in patients with questionable symptoms. Percutaneous instillation of the