Laparoscopic excision of a case of percutaneous cystohepatic fistula in a patient affected by polycystic disease of the liver: point of technique.

A 76-year-old man affected by autosomal-dominant polycystic kidney disease was admitted for a 2-year history of purulent leakage from a cutaneous orifice present in the right hypochondrium. The patient was submitted to a percutaneous aspiration of a big symptomatic cyst in the right liver about 3 years earlier in another hospital. Shortly, an orifice with purulent leakage appeared in his hypochondrium. Two years later, the patient came under our observation. Computed tomography scan showed a polycystic liver with a fistula from a hepatic cyst to the skin. A laparoscopic approach was chosen to dissect the fistulous tract from its liver bed and then a cutaneous incision was performed to resect the en-block fistulous tract and skin containing the cutaneous orifice. Cystocutaneous fistula, as in our patient, is not reported yet; the laparoscopic approach allows treatment in the presence of a fistula and, as in our case, of hepatic cysts.