Long-term outcome after laparoscopic fenestration of simple liver cysts

Background: Simple liver cysts (LCs) represent the most common benign liver disease, with a prevalence of 3-5 %. Laparoscopic fenestration is considered the best treatment for symptomatic LCs, but few studies have analyzed the rate or type of recurrence during a long-term follow-up period (>5 years). Methods: Between January 2000 and December 2010, 47 patients underwent laparoscopic fenestration for simple LCs. The indications were symptoms for 42 patients and an uncertain diagnosis for five patients. The follow-up assessment consisted of regular patient evaluations, with results of laboratory data and liver ultrasound. Results: Conversion to laparotomy was not necessary in any case. The postoperative mortality and morbidity rates were nil. The mean follow-up period was 67 months (range 12-142 months), and 26 patients (55.3 %) had a follow-up period longer than 5 years. During the follow-up period, 40 patients (85.1 %) did not present with any type of recurrence. The overall recurrence rate was 14.9 % (seven patients) based on five patients (10.6 %) with radiologic asymptomatic recurrences detected by ultrasound or computed tomography (CT) scan and two patients (4.3 %) with clinicoradiologic symptomatic recurrences. Both symptomatic recurrences involved LCs located in the right posterior segments. Conclusions: Laparoscopic fenestration provided complete relief of symptoms for about 95 % of patients with simple LCs. Recurrence after surgery was experienced by 14.9 % of the patients, but only in 4.3 % (two patients) was this recurrence symptomatic requiring a second treatment. The site of recurrence was more frequently in the right posterior segments. Laparoscopic fenestration of symptomatic LCs can be considered a safe and effective procedure that can yield good long-term results.