Annali 870

The autoptic incidence of non-parasitic hepatic benign cystic disease is estimated between 0.14 and 0.3 % (1, 2). The symptomatic cysts are even more rare (10-15% of the cysts) (3, 4). In the past such pathology has been surgically approached in different ways (fenestration, resection, enucleation, cysto-enterostomies) and at times non-invasively, the results of which were mediocre (5, 6, 7, 8, 9, 10). In 1991 Z’Graggen and Fabiani proved the feasibility of the laparoscopic approach in the treatment of symptomatic simple hepatic cysts (11, 12). The validity of this technique has been reiterated in other studies (5, 8, 9 13, 14). The above mentioned papers do not include the parasitic cysts and do not analyze the long-term results (9, 10, 15). From a thorough analysis of the literature becomes evident how most of the complications are observed when the laparoscopic technique is extended to hydatid cysts. Katkhouda in his analysis of 31 cases reports a 66% complication rate for echinococcal cysts compared to negligible percentage in the non-parasitic disease (16). These data, along with other similar reports, make us wondering about the validity of laparoscopy for parasitic disease and the accuracy of preoperative diagnosis. The difficult preoperative diagnosis, probably derived from an uncommon observation in many countries, has persuaded some authors to exclude laparoscopy as an option for symptomatic simple hepatic cysts in patients