Perioperative management - Laparoscopic unroofing of simple liver cyst - general and visceral surgery
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Indications
Symptomatic liver cysts: (Fatigue, breathing problems, sensation of pressure/abdominal fullness, nausea, organ displacement induced pain, icterus due to compression of the intra-/extrahepatic bile ducts).
- Solitary nonparasitic benign liver cysts
- Polycystic liver lesions type I (limited number of large cysts on hepatic surface)
Contraindications
- Asymptomatic cysts
- Polycystic liver lesions type II (numerous small cysts in the entire liver)
- Neoplastic cysts (cystadenoma, cystadenocarcinoma)
Relative contraindications include:
- Parasitic liver cysts
- Location: posterior liver segments I, VII, VIII
- Major coagulation disorders
- Cardiopulmonary risk factors
- Cirrhosis
Preoperative diagnostic work-up
Patient history and clinical examination
Abdominal CT or MRI studies
Special preparation
Lab studies (liver function, serum antibody screening for echinococcosis)
Informed consent
General risks:
- Allergy
- Thrombosis
- Embolism
- Cardiovascular reactions
- Pneumonia
- Blood transfusion
- Incisional hernia
Special risks:
- Wound infection
- Intra-abdominal infection
- Secondary bleeding
- Ascites
- Pleural effusion
- Biliary leaks
- Recurrent cyst with recurrent symptoms
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative management
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