Technical challenges in treating recurrent non-parasitic hepatic cysts

• There have been no studies that directly discussed the management of recurrences of these cysts.
• it is important to determine the factors that increase the risk of recurrence.
• Inadequate or insufficient deroofing of the cyst will lead to poor outcome, because of the possibility of the cyst to reform.
• There is no clear consensus and no adequate follow up of patients with recurrent cysts.
• The use of the laparoscopic approach should not change the indications for open surgery.

PurposeSimple non-parasitic hepatic cysts (NPHC) are relatively frequent and often asymptomatic. When symptomatic, surgery is recommended. Most patients can be treated with laparoscopic deroofing. However, recurrence rate varies greatly, and there is no consensus on the optimal approach for symptomatic recurrences.Materials and methodsA retrospective study on 33 patients surgically treated for symptomatic simple NPHC was performed. Recurrence was considered only when symptomatic.ResultsMost patients were initially submitted to laparoscopic deroofing. Symptomatic recurrence was found in five patients treated with laparoscopic deroofing. Specific location of the cysts was a common characteristic. In three cases, recurrence was unsuccessfully treated with open deroofing, and patients were submitted to resection. Open deroofing does not offer any advantage in terms of recurrence in comparison with laparoscopic deroofing.ConclusionLaparoscopic deroofing can be proposed for symptomatic recurrent cysts, except for cysts located in S4, S7 and S8, where recurrence rates are higher and complete resection should be undertaken.