Systematic Review of Laparoscopic Fenestration and Percutaneous Sclerotherapy in the Management of Symptomatic Nonparasitic Simple Liver Cysts

In the management of symptomatic nonparasitic simple liver cysts (SN-SLC), percutaneous sclerotherapy (PS) and laparoscopic fenestration (LF) represent the treatment options of choice. Recently, European guidelines on Interventional Ultrasound indicated PS as a good alternative to LF, with similar efficacy and lower complication rates. However, the choice of the best treatment options for SN-SLC remains a debated matter. Objective of this manuscript is to review the literature and to report on the short and long-term results of PS and LF for patients affected by SN-SLC. A Medline review of articles (July 1988–July 2019) concerning the over mentioned subject was performed. Papers considering pediatric patients, patients affected uniquely by polycystic liver disease, or less than five patients were excluded from the current analysis. Overall, 62 studies met inclusion criteria: one study comparing results of PS and LF, 40 and 21 studies reporting on results following LF and PS, respectively, accounting for an overall study population of 1,658 patients (1,037 and 621, respectively). Abdominal pain, eventually associated to fullness/ discomfort, was the main symptom at diagnosis. Overall morbidity rate was 8% (7.9% and 9.9% among the LF and PS groups, respectively). Mortality rate was nil among LF patients and 0.2% among PS patients. Following cyst treatment, rapid symptoms relief was observed in the majority of patients. Average follow-up duration was of 49 and 29 months among studies investigating LF and PS results, and symptoms recurrence necessitating for additional treatment was observed in 1.6% and 8.2% of patients treated with LF and PS, respectively. While PS, mainly performed using alcohol/minocycline, seems associated with a lower risk of perioperative complications and higher rate of symptoms recurrence, LF is indicated when differential diagnosis with other condition is necessary, in the presence of biliary communication, or after ineffective PS. However, a multidisciplinary decision is recommended for defining the most appropriate treatment.