Introduction : Biliary cystadenomas is a rare cystic hepatic neoplasm with less then 200 cases reported all over the world. Here we report our institutes experience in the varied presentations and management of 30 cases of biliary cystadenomas over the past 12 years.

Methods : Records of 30 patients who underwent treatment for biliary cystadenoma , between 2006 and 2018, were reviewed and retrospectively analysed .

Results : Majority of the patients were females with a median age of 46 years .The most common symptom was pain abdomen .Jaundice was the presenting symptom in 8 patients .Ten patients presented with history of previous surgery for liver lesions .7 patients had presented with recurrence after partial hepatectomy for suspected hydatid cyst ,two patients after marsupuliasation and deroofing for suspected simple liver cyst and one patient after percutaneous drainage for suspected infected hydatid cyst .17 patients underwent enucleation and 11 patients underwent liver resection .4 of the 8 patients who had obstructive jaundice had tumor protrusion into the bile duct which was excised in toto and T tube drainage was done .Patients who underwent surgery didn’t have recurrence in the follow up period ranging from 3 months to 10 years .

Conclusions : Biliary cystadenoma must be differentiated from other cystic lesions of the liver . In the background of normal CA 19-9 and straw coloured cyst fluid , even multiloculated biliary cystadenoma can be safely enucleated .Liver resection can be reserved for patients with recurrence , elevated CA 19-9 and blood stained cyst fluid .