AIM:To evaluate the immediate and long-term results in aseries of patients with highly symptomatic polycystic liverdisease(PLD)treated by combined hepatic resection withcystic fenestration.METHODS:We reviewed our recent experience with acombined hepatic resection-fenestration procedure in sevenhighly symptomatic patients with PLD.Clinical data,livermanifestation of computed tomography(CT),and morbiditywere recorded pre-and post-operation.Follow-up was madeby clinical and CT examinations in all patients.RESULTS:Symptomatic relief and reduction in abdominalgirth were obtained in all patients during an average follow-up period of 20.4 mo.CT scans confirmed post-resectionhypertrophy of the spared liver and lack of significant cystprogression.All patients had mild to severe ascites.Twopatients were complicated with pleural effusion.CONCLUSION:Some highly symptomatic patients withmassive PLD may benefit from combined hepatic resectionand fenestration at acceptable risk,To stitch the dissectedhepatic ligaments could prevent the instable remnant liverfrom kinking and collapsing. AIM: To evaluate the immediate and long-term results in a series of patients with highly symptomatic polycystic liver disease (PLD) treated by combined hepatic resection with cystic fenestration. METHODS: We reviewed our recent experience with acombined hepatic resection-fenestration procedure in seven highly symp sympathetic patients with PLD. Clinical data, livermanifestation of computed tomography (CT), and morbiditywere recorded pre-and post-operation. Frolow-up was madeby clinical and CT examinations in all patients. RESULTS: Symptomatic relief and reduction in abdominal girth were obtained in all patients during an average follow-up period of 20.4 mo.CT scans confirmed post-resection hypeypertrophy of the spared liver and lack of significant cystprogression. All patients had mild to severe ascites.Twopatients were complicated with pleural effusion. CONCLUSION: Some highly symptomatic patients with massive PLD may benefit from combined hepatic resectionand fenestration at acceptable risk, To stitch the dissecte dhepatic ligaments could prevent the instable remnant liverfrom kinking and collapsing.