Laparoscopic treatment of multiple symptomatic biliary cysts

The exact frequency of liver cysts is not known because most do not cause symptoms. It has been estimated that they occur in 5% of the population. No more than 10 to 15% of the patients present symptoms. This video shows a laparoscopic fenestration in a patient presenting with hepatorenal polycystosis with multiple symptomatic hepatic cysts.

Créer un compte gratuit

l'Université Virtuelle

Google translate

Résumé
Chapitres
Vos Commentaires
Interrogez les Experts

Vous devez vous identifier pour accéder à cette partie du site !

Laparoscopic treatment of multiple symptomatic biliary cysts

Authors

D Mutter, J Marescaux

Abstract

The exact frequency of liver cysts is not known because most do not cause symptoms. It has been estimated that they occur in 5% of the population. No more than 10 to 15% of the patients present symptoms. This video shows a laparoscopic fenestration in a patient presenting with hepatorenal polycystosis with multiple symptomatic hepatic cysts.

Catégorie

clinical cases

Mots-clés

Laparoscopic treatment, multiple symptomatic biliary cysts

Type de vidéo

Vidéo chirurgicale

Durée

08'00''

Publication

2009-12

Popularité

Favoris

Favorites Media

Audio

Sous-titres

E-publication

WeBSurg.com, Dec 2009;9(12).
URL: http://www.websurg.com/doi-vd01en2753.htm

Laparoscopic treatment of multiple symptomatic biliary cysts

1. Clinical case presentation 00'09''

We report the case of a patient presenting with hepatorenal polycystosis. Multiple symptomatic hepatic cysts are present. A fenestration of such cysts is decided upon in order to diminish their overall size. These cysts are situated both to the right and to the left lobes of the liver. A primary exploration helps to assess the multiple locations of the cysts. The objective is to free the adhesions underneath the liver. This causes a small bleed close to the liver, which will be controlled using cautery.

2. Adhesiolysis 00'40''

The adhesiolysis is necessary in order to access the cysts localized at the posterior portion of the liver‘s segment VI.

3. First cyst opening 00'48''

Only the most voluminous cysts and those that are easily accessible laparoscopically will be opened. A first cyst attached to the diaphragm is opened immediately. This cyst is the most voluminous and can be found at the liver’s dome.

4. Cyst resection 01'22''

The resection of the dome’s bulging part is decided upon. This is achieved using the Ligasure device, which allows to cauterize the liver parenchyma and to resect the cyst’s wall.

5. Cauterization 01'32''

Cauterization is necessary as it helps avoid any postoperative biliary leak. Indeed, some small bile ducts are systematically encountered at the level of these cysts. If they are not properly cauterized, there is a risk of postoperative complications such as the occurrence of biliary leak.

6. Posterior cyst fenestration 02'12''

Substantial adhesions are visible between this posterior cyst and the diaphragm. These are presumably related to a previous intra-cystic haemorrhage, which would explain the pains endured by the patient. Freeing these adhesions causes some blood loss, thus requiring the use of bipolar cautery along with a drain to suction the blood. The posterior part of the cyst’s wall is freed using monopolar cautery. The bulging dome’s resection margin is delimited by the liver parenchyma. Some liver parenchyma can be seen here on this fragment; this is removed immediately. An extraction bag is introduced into the abdomen to retrieve and collect the pieces of the resected dome. The gauze that had been introduced to ensure the hemostasis is also extracted. A lavage of the hemorrhagic site is carried out. Another gauze pad is applied to control the hemostasis. A few cysts that are readily accessible are emptied, such as a cyst situated at the inferior part of the liver segment III. Here again, for each of these cysts, once fenestrated, a fragment of the bulging dome is resected in order to prevent any potential recurrence. Indeed, despite the resection of the bulging dome, approximately 30% of such cysts may recur after the intervention.

7. Liver segment III-IV fenestration 04'08''

Another voluminous cyst situated at the junction between segment III and segment IV of the liver is also opened and emptied; a part of its wall is resected using electrocautery with the Ligasure device. Here again, the objective is to avoid the early recurrence of this cyst. Following each resection of bulging dome, the absence of biliary leak must be ruled out. At the level of the hemorrhagic cyst situated at the liver segments VI-VII, the liver parenchyma is controlled with the application of local hemostatic agents.

8. Suction drain placement 04'57''

The objective is to avoid any postoperative hematoma. Usually, following the resection of biliary cysts, a suction drain is placed for 48 hours. The aim is twofold: to evacuate a potential bile leak and achieve the drainage of fluids that would not have been suctioned out immediately following cyst fenestration. This laparoscopic treatment proves to be effective in most cases, although 30% of symptomatologic recurrences may be observed.