Laparoscopic management of diaphragmatic mesothelial cysts in children

Diaphragmatic mesothelial cysts (DMC) are rare congenital lesions arising from coelomic remnants. The DMC may need surgical excision if they become symptomatic. The aim of this study was to present three pediatric DMC cases that successfully managed laparoscopically.

Three consecutive children (ages 6, 8 and 12 years), who presented with nonspecific abdominal complaints, referred to our department. Imaging studies demonstrated lobulated cysts in the region of the right posterior lobes of liver. The patients were approached by laparoscopy in a right lateral decubitus position because the preoperative diagnosis is uncertain. Cysts originating from diaphragm were seen, the clear yellowish fluid was aspirated, and unroofing was performed in all patients.

After a well-tolerated operation, postoperative courses of the patients were uneventful, and they were discharged on the following day. Histopathological examinations of the wall of the lesions showed DMC with no evidence of malignancy. No recurrence or symptom was found during the follow-up period.

This is the first report of laparoscopic management of the DMC. Laparoscopic approach to symptomatic DMC patients is safe and effective method for diagnosis and treatment, if it is not established a differential diagnosis by imaging studies.