Laparoscopic De-roofing of Simple Liver Cysts

The information below answer the following FAQs about liver cysts and the role of laparoscopic surgery in de-roofing of simple liver cysts:

 
What are simple liver cysts?
SWhat are the symptoms of simple liver cysts?
How are simple liver cysts investigated?
How are simple liver cysts treated?
What is laparoscopic de-roofing of liver cysts?
What if the liver cyst recurs after de-roofing?
 
What are simple liver cysts?

Simple cysts are by far the most common cystic lesions found in the liver. We are probably born with these cysts (i.e. congenital), which contain yellow fluid but no bile. Whilst often few cysts are found, occasionally these can be multiple and rarely extensive in number such as those found in patients with polycystic liver disease.
 
What are the symptoms of simple liver cysts?

Simple liver cysts are in the most completely innocent, causing no symptoms. Occasionally, however, the cysts can reach large sizes and cause a dull ache or pain in the right upper abdomen and/or right shoulder. Rarely, bleeding can occur within a very large cyst and present with severe right upper abdominal pain that sometimes mimics symptoms of gallstones. Very large cysts can lead to abdominal distension and deformity.
 
How are simple liver cysts investigated?

Simple liver cysts are increasingly and incidentally found during ultrasound or CT scans of the abdomen when these are carried out for other reasons. Their simple cystic nature is often very clearly established on an ultrasound scan and no further tests are therefore required. However, large cysts and those that might have been complicated by internal bleeding might mimic other more serious and relevant cystic lesions of the liver such as cystic tumours (for example, a biliary cystadenoma), hydatid cysts, or even abscesses. Further investigations are then required to establish the diagnosis and differentiate simple cysts from others. These tests could include blood tests to measure tumour markers (i.e. markers that can be significantly raised in the blood of some patients with cancerous lesions) and to detect hydatid antibodies, and more sophisticated imaging techniques such as CT-scan and MRI scan.
 
How are simple liver cysts treated?
 
Since the majority of these cysts are innocent, they can be left alone without the need for further follow up or treatment; reassurance is all that is needed. However, large cyst or cysts that cause significant symptoms will need some form of decompression. The simplest approach is to aspirate the fluid from the cyst under ultrasound guidance. This can be helpful to confirm that the cyst is indeed the cause of the symptoms, though the response is usually short-lived as the fluid within the cyst soon re-accumulates and the symptoms recur. Aspirating the cyst fluid and injecting a chemical agent (such as the antibiotic tetracycline) into the cyst can lead to inflammation and destruction of the lining of the cyst (called sclerotherapy), but unfortunately this is often not enough to prevent the cyst fluid from re-accumulating again with subsequent recurrence of the large cyst and its symptoms. Surgery is a more effective approach and usually involves de-roofing of the cyst.
 
What is laparoscopic de-roofing of liver cysts?
 
As the fluid within the cyst is otherwise harmless, keyhole surgery to remove the part of the cyst wall that bulges out of the liver (called de-roofing or marsupilisation) is a minimally invasive and effective approach to resolve the situation. It allows the fluid produced within the cyst to escape into the abdominal cavity where it is then absorbed into the blood stream without any consequence. This approach prevents the fluid from accumulating within the cyst. However, in a small proportion of patients the cyst walls come together again, heal, and the cyst re-accumulates with subsequent recurrence of the symptoms.
Under general anaesthesia, surgery is carried out through few small incisions (usually three) on the abdomen. Rarely, the surgery might need to be converted to open surgery through a large incision such as if bleeding is encountered. Professor Ammori performs however has performed many of these operations without needing to convert to an open operation. Although the surgery is straightforward in most, it can be quite challenging when performed for very large cysts that are located high up in the liver, close to major vessels, or when the cyst has been complicated by bleeding. Bile leak, bleeding and infection are some of the very infrequent complications of surgery of this nature. Most people are discharged home within 1-2 days. The cyst wall is sent for histological examination in order to confirm the
 
What if the liver cyst recurs after de-roofing?

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