Clinical Review and Operative Management in Patients of Symptomatic Hepatic Cysts

Choi, Donghui; Choi, Inseok; Ye, Byungkuk; Kim, Dongheon; Sim, Moonseop; Lee, Changhoon

Abstract

BACKGROUND/AIMS: Hepatic cysts are incidentally found at laparotomy or through abdominal imaging studies. When they become symptomatic, treatment is indicated. The aim of this study is to evaluate many options of their management, especially about surgical methods.
METHODS
Data were retrospectively analyzed from the clinical charts of 21 patients undergoing surgery for symptomatic hepatic cysts from January, 1995, through December, 2002 in department of Surgery, Pusan University Hosipital. Charts were obtained from the original hosipital referral. We considered the following variables for analysis: age, sex, symptoms, hepatic cyst location, size, operative methods, histological confirm, postoperative morbidity and mortality, length of postoperative hosipital stay, and follow-up outcome.
RESULTS
Mean age of the 21 patients was 53 years. The ratio of male and female was 1:4.3. Their main symptoms were right upper quadrant pain or discomfort, epigastric pain, and abdominal distension. Rarely, palpable mass, dyspepsia, mild jaundice, and acute abdominal pain from ruptured hepatic cyst were observed. Preoperative abdominal ultrasound and computed tomographic scannig were done in all patients. The mean size of hepatic cysts was 9.04 cm in computed tomographic scanning. The 61.9% of patients had the location in right lobe. Simple cyst was characterized by homogeneous, low attenuated and unilocular mass in computed tomographic scanning: in difference, biliary cystadenoma, internal intervening septation and papillary infoldings with cyst itself. Fifteen patients underwent partial cystectomy and 4, complete cystectomy and 1, non-anatomical hepatic resection and 1, left lateral segmentectomy. Hepatic cysts were consisting of 15 cases of simple cyst, 4 cases of biliary cystadenoma, 1 case of Caroli's disease and 1 case of polycystic liver disease. Postoperative complication was bile leakage in one case. No symptomatic recurrence occured during a mean follow-up period of 42.5 months.
CONCLUSION
According to the characteristics of symptomatic hepatic cyst, proper operative methods of management were considered. More long-term follow-up is necessary but in simple cyst in histological type, partial cystectomy can be the acceptable technique, complete cystectomy or hepatic resection should be perfomed in biliary cystadenoma for recurrence and malignant potential.