Laparoscopic Hepatic Cystectomy (removal of a liver cyst)

A. The Condition. You may have a cyst in your liver. These can be the result of an infection. The cyst is removed or destroyed with a laparoscopic hepatic cystectomy.

B. Symptoms. You may have the following symptoms:

• Weakness, fatigue
• Fevers
• Loss of appetite
• Weight loss
• Abdominal pain
• Jaundice (yellow skin)

C. Laparoscopic Hepatic Cystectomy. The surgeon will make about 3-4 small incisions in your abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of your abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to remove or destroy the cyst within your liver. Your surgeon will use a special instrument which cauterizes the liver as it is cut, so that there will be minimal bleeding. If a liver specimen is removed, then it is extracted from your abdomen in a plastic bag by enlarging one of the small incisions. After this has been accomplished, the carbon dioxide is released out of the abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips. When you wake up, you may have a temporary drain or rubber tube exiting out of your skin.

D. Nonsurgical Treatment. For most cysts of the liver, the best treatment is surgical removal, especially if the diagnosis is not known. In some cases, the cyst may be treated by placing a special probe into the cyst; the probe can deliver various types of energy which can destroy the cyst. In some cases of infection, antibiotics may be the preferred treatment. Your doctor will discuss with you what your best treatment option is.

E. Risks. The primary risks of laparoscopic hepatic cystectomy are:

• Infection of the skin at one of the small ports sites
• Decrease in liver function
• Bleeding within the abdomen
• Collection of bile or pus within the abdomen
• Postoperative ileus (the intestines slow down/stop working for several days)

F. Expectations

1. Before Your Operation. Laparoscopic hepatic cystectomy usually is an elective procedure. The preoperative evaluation might include blood work, urinalysis, an abdominal ultrasound, and an abdominal CT scan. In some cases, endoscopy and/or x-rays of your bile duct may be performed. If you smoke, then you should stop immediately. If you are taking blood thinners (for example, aspirin, coumadin, or Plavix), then you will need to stop these one week prior to your procedure. Your surgeon and anesthesia provider will review your health history, medications (including blood thinners), and options for pain control.

2. Your Recovery. You usually can go home in 1 – 2 days after a laparoscopic hepatic cystectomy. You may need to wait until your bowels start working. You will be given medication for pain, and you may need to take antibiotic pills. If you have a drain, then your doctor and/or nurse will instruct you in the care for the drain. You should limit your activity to light lifting (no more than 15 lb) for one month.

3. Call Your Surgeon if you have one or more of the following:

• Severe pain
• Nausea and vomiting
• High fever
• Odor or increased drainage from your incision
• No bowel movements for three days
• Jaundice