When is surgery indicated for simple hepatic cysts?

Updated: Mar 27, 2020
  • Author: Robert E Glasgow, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Most patients with simple cysts are asymptomatic and require no treatment. When the cysts become large and cause symptoms, such as pain, treatment is warranted. Surgical treatment of simple liver cysts involves "unroofing" the cyst by excising the portion of the wall that extends to the surface of the liver. Excision of this portion of the cyst wall at the liver surface produces a saucer-type appearance in the remaining cyst so that any fluid secreted from the remaining epithelium leaks into the peritoneal cavity where it can be absorbed.

Although ablating the remaining epithelium with electrocautery or an argon beam coagulator is possible, this generally is not required because the volume of fluid secreted each day can be absorbed by the peritoneum without any consequence. Furthermore, ablation of the cyst wall can lead to bleeding or bile leak secondary to injury to underlying vessels and bile ducts. The cyst wall should be sent to pathology to confirm the diagnosis and exclude cystadenoma or cystadenocarcinoma as these lesions require enucleation or formal resection in the setting of cancer.

Historically, treatment of symptomatic hepatic cysts required laparotomy, but today, cyst unroofing can be successfully performed laparoscopically. [19] Anecdotal reports of laparoscopic treatment became common by the mid-1990s, and the laparoscopic approach is currently considered the standard of care. [20] As compared with laparotomy, this technique is associated with less postoperative pain and disability, shorter duration of hospital stay, and superior cosmetic results.

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