Successful aspiration and ethanol sclerosis of a large, symptomatic, simple liver cyst: Case presentation and review of the literature

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