To investigate the preoperative evaluation, intraoperative managements of laparoscopic fenestration for non-parasitic hepatic cysts (NPHC) and the prevention strategies for recurrence.

Clinical data of 82 patients with NPHC who underwent laparoscopic fenestration in Tianjin Nankai Hospital from January 2010 to December 2017 were retrospectively analyzed. Among them, 28 patients were male and 54 female, aged (65±13) years on average. 60 patients were diagnosed with simple cysts, 7 cases complicated with cholecystolithiasis, 7 cases with gallbladder polyp and 8 cases with cholecystolithiasis and choledocholithiasis. 63 cases had single cysts and 19 cases had multiple cysts. The informed consents of all patients were obtained and the local ethical committee approval was received. The recurrence risk of NPHC was evaluated based on preoperative CT scan. Intraoperatively, according to the location and exposure of cysts, puncture aspiration of the cyst fluid was performed first, then the exposed surface of cyst wall was excised with high-frequency electric hook, ultrasonic scalpel or Endo-GIA to complete the cyst fenestration, and the residual cavity of cysts was fixed and filled using pedicled greater omentum.

78 cases underwent one-stage laparoscopic fenestration, 4 cases received two-stage laparoscopic fenestration, and no case was converted to open surgery. The mean operation time was (53±15) min, the intraoperative blood loss was (60±17) ml, and the length of postoperative hospital stay was (6.5±1.4) d. No fenestration-induced complications, such as bleeding, bile leakage and abdominal infection, occurred. Postoperative follow-up was ranged from 6.0 to 12.0 months with a median of 9.4 months. The follow-up rate was 88% (72/82). NPHC recurrence was observed in 6 cases by postoperative CT scan, and 4 of them were evaluated with high-risk recurrence before operation. The accuracy rate of preoperative evaluation was calculated as 97% (70/72). Imaging examination showed that the recurrence rate of NPHC was 8% (6/72), including 2 cases of recurrence in segment Ⅶ and Ⅷ, and 1 case in segment Ⅳa +Ⅳb and 1 case in segment Ⅱ, respectively.

Comprehensive preoperative evaluation of the recurrence risk is the premise of successful treatment of NPHC by laparoscopic fenestration. Extensive cyst wall resection, proper exposure of residual cavity and appropriate postoperative drainage can prevent the recurrence of NPHC. The risk of anatomical recurrence is high in segment Ⅳa, Ⅶ and Ⅷ, in which precautions should be noted.