Hepatic cyst fenestration

Hepatic cyst fenestration is used for the surgical treatment of hepatic cysts. This procedure is simple and minimally invasive. It is suitable for decompression drainage of multiple hepatic cysts (polycystic liver) and isolated hepatic cysts without complications. The general effect is good, but sometimes due to the window opening. The window is a cyst recurrence caused by adhesion of the abdominal organs. The surgical procedure is to remove a wall of the capsule and the liver capsule protruding to the surface of the liver. Treating diseases: liver cysts Indication 1. A large single cyst or a single multi-atrial cyst that protrudes from the surface of the liver with obvious clinical symptoms. 2. Multiple liver cysts. One or more of the cysts are large and cause symptoms, and the fenestration of the main lesions is feasible. 3. The diagnosis is clear and the cyst has no complications. 4. The cysts are treated together in other upper abdominal surgery (most often cholecystectomy). Contraindications 1. Neoplastic cystic lesions of the liver. 2. Trafficous liver cysts (such as combined with bile fistula). 3. Polycystic liver. 4. Hepatic cysts with comorbidities. 5. A small cyst with deep and asymptomatic location. 6. Intrahepatic biliary cystic dilatation (Caroli disease). 7. Serious obstacles to the function of important organs. Preoperative preparation 1. Same as general liver surgery. 2. Liver B ultrasound, CT or MRI examination. 3. Functional measurement of important organs (heart, lung, liver, kidney, etc.). 4. Excluding liver echinococcosis, hepatic cystic tumor. 5. If the cyst cannot be excluded from the biliary tract, retrograde cholangiopancreatography should be performed. Surgical procedure 1. Select a suitable abdominal incision based on the location of the cyst. Take the oblique incision under the right costal margin or the right upper abdomen through the rectus abdominis incision. 2. Explore the condition of the whole liver and determine the number and location of the lesion. The cyst to be surgically exposed was exposed, and the fluid was aspirated with a No. 7 or No. 9 needle to examine the properties of the extracted liquid. The liquid of the simple cyst should be a pale yellow clear transparent watery liquid. If the cystic fluid is bloody, turbid or stained with bile, it indicates complications. If the cystic fluid is mucous, it may be a neoplastic cyst. It is not suitable for window surgery. 3. Select the thin part of the cyst wall, cut the wall with a sharp knife, and release the cyst fluid. Use the electrosurgical knife or scissors to remove the fibrous capsule wall and the liver capsule. There may be active bleeding at the junction of the wall of the capsule and the liver tissue. It should be sutured to stop bleeding. Cut the wall to leave a pathological examination. 4. Check the inside of the capsule. Simple cysts are smooth inside the cavity. If there are sputum or papillary projections, the living tissue should be taken for frozen section examination. Attention should be paid to the identification of wrinkles and masses in the capsule. The former contains the remaining blood vessels and bile duct structures after atrophy of the liver parenchyma, and a large amount of bleeding occurs when the incision occurs. If there is no clear bleeding or biliary sac in the cyst, the wall of the sputum can be coated with gauze with iodine to cauterize the epithelial cells with secretory function. 5. After the cyst opens the window, the capsule cavity is opened and no suture is performed. The larger cyst can be filled with a large omentum, and drainage is generally not placed in the lumen and in the abdominal cavity. However, when there is a cyst infection, intracapsular hemorrhage or bile mixed in the cyst fluid, a double cannula should be placed next to the cyst opening window, and the negative pressure suction should be continued after the operation.