Departmental Bulletin Paper Hepatic cyst reduction surgery and its significance for polycystic liver disease
Hepatic cyst reduction surgery and its significance for polycystic liver disease

木村, 理  ,  平井, 一郎  ,  渡邊, 利広  ,  手塚, 康二  ,  菅原, 秀一郎

Purpose.Although there have been many studies on polycystic liver disease (PCLD), most have not considered the effectiveness of computed tomography volumetry for liver resection as part of reduction surgery. In this study, we report the techniques used for liver resection in reduction surgery for PCLD and describe the theoretical basis.Methods.We performed clinical and imaging investigations in five patients with PCLD whose chief complaints were abdominal distention and early satiety.Results.The average plasma indocyanine green retention at 15 min (ICG R15), which indicates hepatic functional reserve, was 11.3 ± 6.7%, indicating moderate liver damage. The average galactosyl human serum albumin uptake during single photon emission tomography uptake for assessing asialoscintigraphy was 50.6% ± 17.8%, indicating slightly decreased uptake. The disease was present in both lobes of the liver in all patients except one, in whom PCLD was localized in the left lobe.Because multiple cysts were present in the hepatic radial margin, we only resected cysts without the surrounding parenchyma when possible. The cyst walls were comparatively tough and firm. Because Glisson’s capsule was present between the cysts, resection was performed with double or triple ligation with transfixing sutures to prevent suture failure and postoperative biliary leakage. Only one patient reported symptom recurrence because of enlargement of cyst remnants.The average preoperative and postoperative total liver volumes were 4644 ± 1813 cm3 and 2698 ± 1615 cm3, respectively, indicating a significant decrease (p < 0.01). The average preoperative cyst volume was 3765 ± 1780 cm3, which decreased to 1894 ± 1546 cm3 after surgery, indicating a significant 35% decrease in cyst volume (p < 0.01). The average preoperative and postoperative noncystic volumes were 880 ± 80 cm3 and 805 ± 173 cm3, respectively, indicating no significant loss of liver parenchyma.Conclusion.The goal of liver resection in PCLD is bulk reduction to alleviate abdominal distention and early satiety. All patients in this study were alive at the time of publication, indicating that the surgery allows patients to survive beyond a few years.

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