Laparoscopic liver resection for polycystic liver disease

Introduction: Polycystic liver disease is uncommon and usually asymptomatic. Surgery is indicated for patients with symptoms or complications. Cyst fenestration has been the main surgical option despite the relatively high recurrence rate. Open hepatectomy and fenestration provided sustainable symptomatic relief in selected patients at the cost of higher morbidity. The role of laparoscopic hepatectomy (LH) for this entity remains unclear. Methods: A retrospective review of patients with polycystic liver disease receiving LH was undertaken. LH in this study referred to the removal of part of normal liver or complex cysts by dividing Glissonean pedicles to the specimen, excluding simple cyst fenestration. Indication for surgery included symptoms related to mass effect with image-confirmed compression on stomach or duodenum and cyst infection. Results: From December 2004 to September 2016, a total of 14 patients (12 females and 2 males) with a mean age of 55.9 ± 14.0 years had been enrolled. Gigot's classification in this series includes type I in 3, type II in 8, and type III in 3 cases. Extent of liver resection includes partial S2 and S3 in 6, partial S2 and S3 with associated partial S5 and S6 or S7 in 3, partial S5, S6, and S7 in 1, partial S6 and S7 in 1, left hepatectomy in 2, and right hepatectomy in 1. Perioperative outcomes include median operation time of 240 min (60–300, interquartile range [IQR]: 150), estimated blood loss of 50 ml (5–2000, IQR: 98.8), and mean postoperative hospital stay of 5.5 days (2–77, IQR: 7.3). The 90-day postoperative complications developed in three patients, mainly bile leak and pleural effusion. There was no postoperative mortality. Conclusion: Laparoscopic liver resection and fenestration for polycystic liver disease seem safe and feasible. The perioperative outcomes were acceptable although the bile leakage rate was relatively high. Careful patient selection to choose peripheral lesions is advisable.