[Cystic diseases of the liver and biliary tract (except for hydatid cyst). Role of surgery].

The role of surgery in cystic diseases of the liver and biliary tract depends upon the kind of cysts. When they are symptomatic, solitary cysts of the liver may require laparoscopic unroofing. Mucinous cystadenoma should be resected since there is a risk of cystadenocarcinoma. Polycystic liver disease may require surgery when massive hepatomegaly results in pain or a worsening of the patient's general condition. Laparoscopic fenestration and partial hepatectomy are only indicated in a small number of selected patients with large or localized cysts. Orthotopic liver transplantation may be recommended in symptomatic cases with massive hepatomegaly even if there is no renal failure and no need for renal transplantation. Caroli's syndrome localized in one lobe or one segment should be resected since it leads to cholangiocarcinoma in more than 10% of cases. When cystic dilatations are diffuse, liver transplantation may be required. Choledochal cysts should be completely resected since cancer may arise in non resected parts. Complete resection may be associated with major hepatectomy.