Liver cysts (also called hepatic cysts) are fluid-filled sacs that occur in the liver of roughly 5% of the population. They are usually asymptomatic and often discovered by chance during an abdominal imaging procedure, like computed tomography (CT) or magnetic resonance imaging (MRI). Even though most liver cysts are benign, an early diagnosis is critical for proper treatment of the parasitic or cancerous subtypes. In most cases, treatment involves removal via minimally invasive surgical techniques.
Liver cysts fall into several categories with varying causes, diagnoses, and treatments.
- Simple cysts are present from birth and are formed by abnormal bile duct cells during the embryos development. Cysts contain a bile-like fluid and are covered with a thin layer of epithelial cells. They are the most common type of liver cyst and generally measure less than 3 cm in diameter.
- Echinococcosis is an infection by a species of tapeworm that is transmissible between animals and humans. Specifically, the larval stage of the Echinococcus granulosus (E. granulosus) and Echinococcus multilocularis (E. multilocularis) species produces liver cysts in humans. Humans become infected by ingesting the parasites eggs, which are found in the excrement of the animal host (e.g. sheep and dogs). Echinococcosis is still not common in the United States, though it has nevertheless become more common over the past several decades in both the U.S. and Europe. It could become gradually more common as wild animals like foxes become more prevalent in areas where people live and keep pets.
- Cystadenoma and cystadenocarcinoma represent benign and cancerous cystic tumors, respectively. Cystadenomas are similar to simple cysts in that they are of epithelial origin and present from birth. The mechanism by which the cystic tumors become cancerous is not known. Cystadenocarcinomas grow slowly and have a mean diameter of 12 cm.
- Polycystic liver disease (PLD) is a rare genetic disorder signified by the presence of greater than 20 liver cysts. The cysts are present from birth and cluster together. PLD is closely associated with two other disorders: autosomal dominant polycystic liver disease (PCLD) and autosomal dominant polycystic kidney disease (ADPKD).
Liver cysts generally do not affect liver function and may remain asymptomatic for years. When cysts become enlarged, they can rupture or push against other organs, causing bloating, a feeling of fullness, and a sudden pain in the upper right abdominal region. Parasitic cysts (echinococcosis) may also cause fever, bloody sputum, and severe skin itching. The type of echinococcosis caused by E. multilocularis (called alveolar echinococcosis) can cause symptoms similar to cirrhosis or liver cancer.
Treatment includes laparoscopic surgery.
Benefits of laparoscopic procedures include less post operative discomfort since the incisions are much smaller, quicker recovery times, shorter hospital stays, earlier return to full activities and much smaller scars. Furthermore, there may be less internal scarring when the procedures are performed in a minimally invasive fashion compared to standard open surgery.
Laparoscopic Liver Cyst Drainage
Cysts in the liver are frequently found in normal people. Liver cysts should only be treated if they are causing significant symptoms to the patient. The symptoms found with liver cysts include pain, bleeding into the cysts causing pain, and digestive complaints that are unexplained by other findings. If a liver cyst requires treatment, surgical treatment should include removal of the wall of the cyst.
Removal of the fluid only from the cyst is not recommended since the cyst fills up rapidly after the procedure. Furthermore this procedure puts the patient at risk for infection of the cyst. We offer a laparoscopic approach to patients who require treatment of liver cysts. The procedure involves removing part of the wall of the cyst so that the liquid that is in the cyst can freely drain into the abdominal cavity. The body then removes the liquid from the abdominal cavity.