Visit our Liver surgery center for the removal of Liver Cysts
Liver cysts occur in about 5% of the general population and up to 10% of those will develop symptoms such as pain, nausea, discomfort, bloatedness, early satiety, and weight loss. Percutaneous or laparoscopic liver biopsy should not be done to diagnose a liver cyst. Percutaneous aspiration and drain placement by an interventional radiologist is not recommended , since it is associated with essentially 100% failure rate. The hepatic cyst fluid quickly reaccumulates after a percutaneous aspiration with recurrence of symptoms. When a liver cyst becomes large, it stretches the liver capsule which can cause the above symptoms. Liver cysts can be singular or multiple and they can occur anywhere in the liver.
Right upper quadrant ultrasound is commonly ordered by primary care physicians as the initial diagnostic imaging for hepatobiliary diseases. When an ultrasound reveals abnormality within the liver, biliary duct or gallbladder, a high-quality CT scan is required for further evaluation.
Most liver cysts contain clear straw-colored fluid but some patients may bleed into the cyst causing sudden right upper quadrant pain or shoulder discomfort. In these cases, the severity of symptoms often triggers a visit to the emergency room.
While most benign and or symptomatic cysts do not require immediate surgical intervention, treatment of symptomatic liver cyst involves removal of a large portion of the cyst wall (unroofing/fenestration), followed by an evaluation by a pathologist to identify or rule out presence of premalignant cells within the cyst wall.
Some patients require partial liver resection to remove a small part of attenuated liver parenchyma to avoid cyst recurrence. This is especially true for hepatic cysts located in the right lobe of the liver or dome of the liver against the diaphragm. When the hepatic cyst unroofing surgery is not done adequately, about 15% of patients experience recurrence of cyst and recurrence of symptoms. Rarely, a formal liver resection removing the entire right/left liver lobe is necessary. it is very important to see a liver surgeon/ liver specialist for a surgical consultation.
An experienced liver surgeon can detect features of complex hepatic cyst ( thickened wall, hypervascular wall, hypervascular septae within the cyst cavity), which indicate potential premalignant changes. A communication with the biliary tract is also important to recognize, in order to avoid bile leak after the hepatic cyst surgery /resection.If premalignant or malignant cells are found in the resected cyst wall, a formal liver resection is then necessary to completely remove the cyst wall. This operation is done in using similar techniques as the liver cancer surgery. A robotic minimally invasive liver resection is our preferred method, which results in shorter recovery, minimal potential complications, and excellent outcomes.
Dr. Iswanto Sucandy performs this operation laparoscopically via a small, scarless single incision in the umbilicus. Most patients are discharged on the same day, only a small number of patients require an overnight stay in the hospital, generally related to other existing medical conditions. At 3 months following the laparoscopic hepatic cyst unroofing/resection, a CT scan is obtained to confirm resolution of the hepatic cyst. Complete hypertrophy of the remaining liver parenchyma is also expected.