Table 4.
Comparison of treatment options for symptomatic simple liver cysts
| Treatment options | Advantages | Disadvantages |
| Observation alone | - Because most cysts are asymptomatic, intervention is unlikely to be helpful and may be harmful | - Only effective cyst treatment can prove whether symptoms are related to the cyst |
| US-guided aspiration | - Simple procedure | - High recurrence rate |
| - May be used as a diagnostic test to assess whether symptoms are related to the cyst | ||
| US-guided aspiration with sclerotherapy | - Relatively non-invasive | - Less effective for uncooperative patients |
| - Complications are rare | - Can not be performed if cyst communicates with biliary tree | |
| - Effective | ||
| - Possible in poor surgical candidates | ||
| Laparoscopic unroofing | - Technically feasible and effective in > 80% cases | - More invasive |
| - Improved results with extensive fenestration and argon beam coagulation or electrocoagulation | - Morbidity in up to 25% | |
| - Low recurrence rate (0%-20%) | - Less effective for cysts which are superior, posterior, or deep within hepatic parenchyma | |
| - Visualization of cyst interior (exclude other diagnoses) | - Less effective if prior surgery has been attempted | |
| Laparotomy (resection, fenestration, or excision) | - Effective | - Most invasive |
| - Allows treatment of laparoscopically inaccessible cysts | - Larger scars | |
| - Useful for cysts with complications | - Longer hospital stays compare to laparoscopy | |
| - May perform cystojejunostomy at time of laparotomy for cysts with biliary communication | - Significant post-surgical morbidity |