Korean J Hepatobiliary Pancreat Surg.  2012 Nov;16(4):134-137. 10.14701/kjhbps.2012.16.4.134.

Managements of simple liver cysts: ablation therapy versus cyst unroofing

• Kim SR
• Lee DS
• Park IY

• KMID: 2243190
• DOI: http://doi.org/10.14701/kjhbps.2012.16.4.134

Abstract

BACKGROUNDS/AIMS
Simple liver cysts were easily recognizable with the advanced imaging procedures, such as ultrasound and computed tomography scan. A large cyst or significant symptoms were indications for the treatments. Ablation therapy with sclerotic agents was effective, but there were several complications including severe pain. With the surgical cyst unroofing method introduced, we compared the cyst unroofing method and ablation therapy.
METHODS
Between March 1997 and May 2011, we performed treatments of simple liver cysts in 27 patients. There were 23 women and 4 men (age range: 42-84 years; mean age: 64 years). The cyst unroofing was undergone with laparoscopic (n=13) and open technique (n=1). The ablation therapy was performed with ethanol (n=13) and acetic acid (n=1).
RESULTS
The usual symptoms of the liver cysts were abdominal mass (n=7), indigestion (n=4), abdominal discomfort (n=3), and the increasing size of the cysts (n=4). The mean diameter of the cysts was 10.9 cm. The cyst unroofing method was performed effectively in 14 patients. One patient had bleeding during operation, and was converted to the open technique. One patient had a bile leak from the cyst, but it was successfully closed with the laparoscopic technique. Among the 14 cases with the ablation therapy, there were 4 complications: hematoma (n=1); cyst leaking during aspiration (n=2); acute renal failure (n=1); and death due to acetic acid intoxication (n=1).
CONCLUSIONS
Laparoscopic cyst unroofing was more effective and safer in management than the ablation therapy in simple liver cysts.

Keyword

Liver cyst; Ablation; Cyst unroofing

MeSH Terms

Acetic Acid
Acute Kidney Injury
Bile
Dyspepsia
Ethanol
Female
Hematoma
Hemorrhage
Humans
Liver
Male
Acetic Acid
Ethanol

Figure

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  Fig. 1 A pigtail catheter was inserted into the cyst under ultrasound guidance.

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  Fig. 2 The cyst was aspirated and unroofed with excision of the wall near the liver tissue by ultrasonic scalpel through laparoscopic approach.

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  Fig. 3 Abdominal ultrasound shows a well-defined hypoechogenic lesion.

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  Fig. 4 Abdomen computed tomography shows a well-demarcated lesion with low density and without enhancement after contrast administration.

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