Comparison of a novel endoscopic approach versus laparoscopic deroofing for symptomatic simple hepatic cysts.

Background: Laparoscopic hepatic cyst deroofing (LHCD) stands as the preferred treatment modality for simple hepatic cysts (SHCs), but it has limitations. This study aimed to introduce endoscopic transgastric hepatic cyst deroofing (ETGHCD) as a minimally invasive alternative and to compare its safety and efficacy with LHCD in treating SHCs.

Methods: We retrospectively enrolled 10 patients with 15 symptomatic SHCs treated by ETGHCD and 53 patients with 72 SHCs treated by LHCD at Shanghai General Hospital from June 2021 to August 2024. Based on anatomical complexity, patients were categorized into a standard-difficulty laparoscopy group (S2, S3, S5, S6, S4-inferior) and a high-difficulty laparoscopy group (S1, S7, S8, S4-superior). Comparisons were performed in patient characteristics, treatment outcomes, and follow-up data in each group.

Results: ETGHCD and LHCD were comparable in safety and both achieved a 100% success rate with complete symptom relief, with no serious complications reported. Notably, the ETGHCD group exhibited significantly lower post-procedure pain scores (0.40 ± 0.52) than the LHCD group (5.81 ± 2.94). During a median follow-up of 22.4 months, no symptom recurrences occurred in the ETGHCD group, whereas 3 patients (5.7%) in the LHCD group experienced recurrences. Both treatments significantly reduced cyst volume (ETGHCD: 85.97 ± 10.93%, LHCD: 77.28 ± 27.22%). Stratified analysis by liver segment revealed that ETGHCD achieved more favorable outcomes for the patients in the high-difficulty laparoscopy group, but no difference for the patients in the standard-difficulty laparoscopy group.

Conclusion: ETGHCD demonstrated comparable safety and efficacy to LHCD in treating SHCs, with reduced post-procedure pain and potential benefits for treating SHCs in S1, S7, S8, S4-superior.