Shahidur Rahman, Professor. Bangobandhu Sheikh Mujib Medical University
Introduction: Simple liver cyst is the solitary non parasitic cystic lesion of the liver.Teatment of symptomatic liver cyst varies from simple aspiration to hepatic resection.Each treatment has its own merits and associatied complications.Laparoscopic unroofing(fenestration) offers the best balance between efficacy and safety. Polycystic liver disese(PCLD) treatment by this method are less clear because of high failure rate.Liver resection though more effective carries higher risks.Treatment of hydatid disease are controversial.
Materials and method: Simple cyst may be asymptomatic and picked up as incidental findings on ultrasound examination for other abdominal complaints.Few cyst have symptoms of mass effect or with complication effect due to haemorrage ,rupture,infection. On examination liver is palpable. Compression over bile duct give rise to jaundice. The commonest symptoms are pain, early satiety, nausea and vomiting.Simple cyst are more common in female after 50 yrs of age.The cyst located antriorly inferiorly and laterally are the ideal case.Investigation like ultrasonography is important.It will helps us to detect the cyst nature, will help to differentiate bet ween simple cyst from poly cystic liver disease, from neoplastic liver. In endemic area of hydatid liver disease serological test is mandatory.CT scan is important regarding details information about to localise the cyst,to identify the liver tissue arroud the cyst,relationship of cyst with the nearby vital structures,number of cyst, calcification and carcinomatous changes in its wall.Aspiration of cystfluid , biological and cytological examination to rule out the presence of infection,biliary communication and malignancy. Recently, CA 19-9 estimation is helpful for the differentiating the simple cyst from the cystadenoma or carcinoma.For jaundice patient ERCP is impotant to locate the intraductal polyp causing the biliary obstruction or cyst causes the compression of the biliary tree.For bleeding in cyst MRI is helpful. Carcinoma at epithelial lining may occur.
Result: Laparoscopic de-roofing (fenestration) less radical procedure ensures adequate drainage of cyst content into the peritoneal cavity.The cyst wall can be removed using harmonic scalpel so smoked produced and fogging of lens can be minimized.The interior surface inspected with care to exclude neoplastic growth and biliary communication.Whole operative procedure, duration of postoperative recovery,hospital stay is much shorter in this procedure. Large cevron incision can be avoided. No recurrence in two years follow up period.Liver resection and total cystectomy theoretically minimizes the recurrence risk but invoke the a real risk of postoperative complications and death.
Conclusion: Careful case selection and meticulous surgical skills are the two major determinants of the outcome.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86631
Program Number: P516
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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