Risk for laparoscopic fenestration of liver cysts

Background: Laparoscopic fenestration is considered the best treatment for symptomatic simple liver cysts.\r\nConversely, the laparoscopic approach for the management\r\nof hydatid simple liver cysts is not widely accepted because of the risk for severe complications.\r\nDespite improvement in imaging techniques, the probability\r\nof preoperatively mistaking a hydatid liver cyst for a simple liver cyst remains about 5%. Therefore,\r\nlaparoscopic fenestration, planned for a liver cyst could be performed unintentionally for an undiagnosed hydatid liver cyst.\r\nMethods: From January 2000 to January 2001, 15 patients\r\nwith a diagnosis of liver cyst underwent laparoscopy\r\nfor fenestration. In all cases preoperative serologic\r\nand imaging assessment had excluded hydatid liver cyst.\r\nTo further exclude hydatid liver cyst, preliminary aspiration of the cyst with assessment of cystic fluid characteristics was performed.\r\nResults: In two patients with presumedly simple liver\r\ncyst, hydatid liver cyst was diagnosed instead at laparoscopy\r\nby aspiration of cystic fluid. The procedure was converted to laparotomy with subtotal pericystectomy.\r\nConclusions: The risk of misdiagnosing a hydatid liver cyst for a simple liver cyst, especially in the presence of a\r\nsolitary cyst, should be considered before laparoscopic\r\nfenestration is performed. Intraoperative aspiration of\r\ncyst fluid before fenestration can minimize this risk, thus\r\navoiding severe intraoperative and late complications.