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Alqahtani A, Almayouf M, Billa S, Alsarraj O, Zamil AB. A splenic pseudocyst following laparoscopic sleeve gastrectomy: a case report. J Surg Case Rep 2023; 2023:rjac624. [PMID: 36636658 PMCID: PMC9831648 DOI: 10.1093/jscr/rjac624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
This is the first report of a patient presenting with a splenic pseudocyst following laparoscopic sleeve gastrectomy (LSG). A 26-year-old male with no chronic medical illnesses who underwent LSG presented with vague abdominal pain. An abdominal contrast-enhanced computed tomography revealed a 15 cm well-circumscribed cyst originating from the spleen. Intraoperatively, the findings were significant for a superficial cyst located at the lower pole of the spleen. A laparoscopic spleen-preserving procedure was conducted, specifically marsupialization and packing with omentum. The postoperative period was uneventful, and the patient was discharged on Day 2 postoperatively. The patient was free from complaints at outpatient follow-up clinics. Follow-up visits at the outpatient clinic were free from complaints. Pathology confirmed a splenic pseudocyst, and cytology was unremarkable. Since dissection during LSG is close to the spleen, infarction could occur, predisposing to pseudocyst formation. Marsupialization is an excellent surgical option when applied to appropriate splenic cyst types.
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Affiliation(s)
- Awadh Alqahtani
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Almayouf
- Correspondence address. Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj 11942, P.O. Box: 173, Saudi Arabia. Tel: +966 011 588 8888; E-mail:
| | - Srikar Billa
- Department of Surgery, Sulaiman Al-Habib Hospitals, Riyadh, Saudi Arabia
| | - Omar Alsarraj
- Department of Surgery, Sulaiman Al-Habib Hospitals, Riyadh, Saudi Arabia
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2
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Ushakov KV, Askerov RF, Chundokova MA, Zalikhin DV, Dondup OM. [Laparoscopic partial resection of spleen in a 15-year-old girl]. Khirurgiia (Mosk) 2023:100-105. [PMID: 37379412 DOI: 10.17116/hirurgia2023071100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Non-parasitic splenic cysts account for 0.5-10% of diseases of this organ. Incidence of splenic cysts has increased in recent years that may be associated with widespread use of abdominal imaging. Symptoms are absent in most cases. Splenic cysts > 5 cm are prone to complications such as bleeding, rupture or infection. These patients require surgical treatment. The authors present multilocular splenic cyst in a 15-year-old patient. The girl was followed-up for 2 previous years due to asymptomatic small cyst. However, cyst enlargement required surgical treatment. Examination revealed multilocular cyst 7×10 cm in the upper pole of the spleen. Enzyme immunoassay did not reveal antibodies to echinococcus. Laparoscopic partial resection of spleen was performed. This case is an example of modern surgical approach for nonparasitic splenic cysts characterized by minimally invasive organ-sparing technologies.
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Affiliation(s)
- K V Ushakov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - R F Askerov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M A Chundokova
- Pirogov Russian National Research Medical University, Moscow, Russia
- N.F. Filatov Children's City Clinical Hospital, Moscow, Russia
| | - D V Zalikhin
- Pirogov Russian National Research Medical University, Moscow, Russia
- N.F. Filatov Children's City Clinical Hospital, Moscow, Russia
| | - O M Dondup
- Pirogov Russian National Research Medical University, Moscow, Russia
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3
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Krichen I, Maazoun K, Kitar M, Kamal NM, Khan U, Khalif MY, A R, Assiri H, Bokari KA. Huge Non-parasitic Mesothelial Splenic Cyst in a Child: A Case Report and Literature Review. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2021; 15:11795565211021597. [PMID: 34158804 PMCID: PMC8182210 DOI: 10.1177/11795565211021597] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
Background: Splenic cysts are one of the relatively rare conditions in pediatric surgery
practice. Primary non-parasitic splenic cysts are even more scarce. Case presentation: A 13-years-old female patient presented with chronic left hypochondrial pain
of 2 months duration. Abdominal ultrasonography and computed tomography
revealed huge 18 cm × 14 cm × 10 cm splenic cyst. Deroofing of the cyst was
done which was complicated by secondary infection. Subsequently, the patient
was re-operated on and partial splenectomy done with good outcome at
6 months follow up. Conclusion: Partial splenectomy is the best management strategy for huge non-parasitic
splenic cysts in children. There is also less recurrence rate of splenic
cysts with preservation of splenic functions.
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Affiliation(s)
- Imed Krichen
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Kais Maazoun
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Murad Kitar
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Naglaa M Kamal
- Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ubaidullah Khan
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Mostafa Yl Khalif
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Rasha A
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Haifa Assiri
- Alhada Armed Forces Hospital, Taif, Saudi Arabia
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4
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Costi R, Castro Ruiz C, Romboli A, Wind P, Violi V, Zarzavadjian Le Bian A. Partial splenectomy: Who, when and how. A systematic review of the 2130 published cases. J Pediatr Surg 2019; 54:1527-1538. [PMID: 30665627 DOI: 10.1016/j.jpedsurg.2018.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/05/2018] [Accepted: 11/25/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE In order to avoid consequences of total splenectomy (including severe postsplenectomy sepsis), partial splenectomy (PS) is increasingly reported. Without guidelines and indications concerning a rarely-indicated procedure, a review of literature should be an asset. METHODS A systematic review of all PSs from 1960 to December 2017 was performed, with special focus on surgical indications, sites of resection, approaches and techniques of vascular dissection and parenchymal section/hemostasis of the spleen, perioperative morbidity/mortality, including complications compelling to perform total splenectomy. RESULTS Among 2130 PSs, indications for resection were hematological disease in 1013 cases and nonhematological conditions in 1078, including various tumors in 142 and trauma in 184. Parenchymal transection was performed using several techniques through the years, most frequently after having induced partial ischemia by splenic hilum vascular dissection/ligation. 371 laparoscopic/robotic PSs were reported. Rescue total splenectomy was required in 75 patients. CONCLUSIONS Although good results are probably overestimated by such a retrospective review, PS should be considered as a procedure associated with a low morbidity/mortality. Nevertheless, severe complications are also reported, and the need of total splenectomy should not to be minimized. Laparoscopic/robotic procedures are increasingly performed, with good results and rare conversions. TYPE OF STUDY Systematic review. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Renato Costi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia.
| | | | - Andrea Romboli
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Philippe Wind
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France
| | - Vincenzo Violi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia
| | - Alban Zarzavadjian Le Bian
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France; Laboratoire d'Ethique Médicale et de Médecine Légale, Université Paris "Descartes", Paris, France
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5
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López JJ, Lodwick DL, Cooper JN, Hogan M, King D, Minneci PC. Sclerotherapy for splenic cysts in children. J Surg Res 2017; 219:1-4. [DOI: 10.1016/j.jss.2017.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/10/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
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6
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Delforge X, Chaussy Y, Borrego P, Abbo O, Sauvat F, Ballouhey Q, Irtan S, Arnaud A, Ibtissam K, Panait N, Rodesch G, Steyaert H, Schneider A, Dubois R, Mesureur S, Haraux E, Buisson P. Management of nonparasitic splenic cysts in children: A French multicenter review of 100 cases. J Pediatr Surg 2017; 52:1465-1470. [PMID: 28185630 DOI: 10.1016/j.jpedsurg.2017.01.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/12/2016] [Accepted: 01/14/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The management of nonparasitic splenic cysts (NPSC) remains controversial. Surgical resection is indicated for symptomatic or complicated forms, but no guidelines are available for asymptomatic NPSC. The aims of this study were to evaluate the management of NPSC in French hospitals and to analyze the results of management. METHODS We conducted a retrospective multicenter study from January 2004 to December 2014 in 16 university hospitals in France. Patients with a follow-up less than 6months were excluded. Data were extracted from the medical reports. RESULTS One hundred patients were included. Median follow-up was 12.8months. No complications were observed for NPSC smaller than 5cm. The size of NPSC increased significantly between the ages of 10 and 12years. Fifteen patients were under observation; 58.3% of cysts decreased in size and 41.7% remained stable. Among the 85 operated patients, no recurrence occurred in the splenectomy group, while 11 recurrences were observed in the cystectomy group (57.9%), 3 of which required redo surgery. CONCLUSIONS Observation is a safe treatment option for asymptomatic NPSC smaller than 5cm. Surgery is indicated for symptomatic patients, and can be proposed for asymptomatic NPSC larger than 5cm. Laparoscopic partial splenectomy is the technique of choice. Follow-up must be continued until the end of puberty. LEVELS OF EVIDENCE RATING Level III.
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Affiliation(s)
- Xavier Delforge
- Department of Pediatric Surgery, CHU Amiens, 80054, Amiens, France.
| | - Yann Chaussy
- Department of Pediatric Surgery, CHU Jean Minjoz, Besançon, France
| | - Paula Borrego
- Department of Pediatric Surgery, CH Lapeyronie-Arnaud de Villeneuve, Montpellier, France
| | - Olivier Abbo
- Department of Pediatric Surgery, CHU Purpan, Hôpital des enfants, Toulouse, France
| | - Frédérique Sauvat
- Department of Pediatric Surgery, CHR Felix Guyon, 97405 St Denis, Reunion Island, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, University Hospital, Limoges, France
| | - Sabine Irtan
- Department of Pediatric Surgery, Trousseau Hospital, Paris, France
| | - Alexis Arnaud
- Department of Pediatric Surgery, Hôpital sud, CHU Rennes, Rennes, France
| | - Kassite Ibtissam
- Department of Pediatric Surgery, Children University Hospital, Tours, France
| | - Nicoleta Panait
- Department of Pediatric Surgery, Aix-Marseille Université, APHM, CHU Hôpital Nord, Marseille, France
| | - Gregory Rodesch
- Department of Pediatric Surgery, Hôpital Universitaire des Enfants Reine Fabiola, Université libre de Bruxelles, Bruxelles, Belgium
| | - Henri Steyaert
- Department of Pediatric Surgery, Hôpital Universitaire des Enfants Reine Fabiola, Université libre de Bruxelles, Bruxelles, Belgium
| | - Anne Schneider
- Department of Pediatric Surgery, Hautepierre Hospital, University Medical Center, Strasbourg, France
| | - Rémi Dubois
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | | | - Elodie Haraux
- Department of Pediatric Surgery, CHU Amiens, 80054, Amiens, France
| | - Philippe Buisson
- Department of Pediatric Surgery, CHU Amiens, 80054, Amiens, France
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7
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Accinni A, Bertocchini A, Madafferi S, Natali G, Inserra A. Ultrasound-guided percutaneous sclerosis of congenital splenic cysts using ethyl alcohol 96% and minocycline hydrochloride 10%: A pediatric series. J Pediatr Surg 2016; 51:1480-4. [PMID: 27320839 DOI: 10.1016/j.jpedsurg.2016.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The management of congenital splenic cysts continues to evolve. In the past the standard treatment was splenectomy, but increased knowledge about the spleen's immunologic function has led most pediatric surgeons to preserve splenic tissue. A great number of studies using sclerosing substances have been published, but to date reports in children have been limited. Our study concerns a group of 15 children with congenital splenic cysts treated with percutaneous drainage and sclerosis with alcohol. We performed the procedure under general anesthesia and checked radiologically for possible leakage. METHODS In 2000 our group started managing pediatric patients with splenic cysts. During the first eight years surgery was the treatment of choice. From April 2008 to December 2014, a prospective study was conducted on 15 consecutive patients treated with percutaneous sclerotherapy. The outcomes regarding cystic dimensional variations before and after treatment were analyzed. RESULTS In 20% of patients complete disappearance of the cystic lesion was achieved. In 67% of the patients the maximum diameter of the cyst was reduced to below 50mm. CONCLUSION Our results should encourage the use of this treatment because it is a valid and safe option in childhood. The high success rate achieved with percutaneous drainage and sclerotherapy of cystic lesions supports our results.
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Affiliation(s)
- Antonella Accinni
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
| | - Arianna Bertocchini
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome.
| | - Silvia Madafferi
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
| | - Gianluigi Natali
- Interventional Radiology Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
| | - Alessandro Inserra
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
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8
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Kapp J, Lewis T, Glasgow S, Khalil A, Anjum A. Spleen preserving management of a non-parasitic splenic cyst in pregnancy. Ann R Coll Surg Engl 2016; 98:e114-7. [PMID: 27167310 DOI: 10.1308/rcsann.2016.0165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Non-parasitic splenic cysts are rare entities. In pregnancy, they are rarer still, with as few as seven cases reported in the literature. There is little consensus regarding the optimal management of this condition in pregnancy. Although small, the theoretical risk of intrapartum splenic rupture is associated with a fetal mortality rate as high as 70%. The authors of at least three case reports advocate total splenectomy as first-line management of splenic cyst in pregnancy. Paradoxically, spleen conserving surgery is the recognised gold standard treatment for symptomatic splenic cysts in non-pregnant patients. We present a case of a large maternal splenic cyst that was treated successfully with a laparoscopic cystectomy.
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Affiliation(s)
- J Kapp
- University College London , UK
| | - T Lewis
- Epsom and St Helier University Hospitals NHS Trust , UK
| | - S Glasgow
- Epsom and St Helier University Hospitals NHS Trust , UK
| | - A Khalil
- Epsom and St Helier University Hospitals NHS Trust , UK
| | - A Anjum
- Epsom and St Helier University Hospitals NHS Trust , UK
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9
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Tennakoon A, Jodlowski T, Carney K. Laparoscopic Partial Cystectomy for Non-Parasitic Splenic Cyst: A Case and Literature Review. JOURNAL OF MEDICAL SCIENCES 2015. [DOI: 10.3923/jms.2016.1.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Partial splenectomy in the era of minimally invasive surgery: the current laparoscopic and robotic experiences. Surg Endosc 2015; 29:3618-27. [PMID: 25740639 DOI: 10.1007/s00464-015-4118-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/13/2015] [Indexed: 12/13/2022]
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11
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Zhang Y, Chen XM, Sun DL, Yang C. Treatment of hemolymphangioma of the spleen by laparoscopic partial splenectomy: a case report. World J Surg Oncol 2014; 12:60. [PMID: 24656049 PMCID: PMC3994486 DOI: 10.1186/1477-7819-12-60] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 03/14/2014] [Indexed: 12/15/2022] Open
Abstract
Hemolymphangioma is a malformation of both lymphatic and blood vessels. The incidence of splenic hemolymphangioma is extremely rare. Laparoscopic partial splenectomy is feasible, reproducible, and safe in children with focal splenic tumors. We report on the case of a 12-year-old male with a large splenic hemolymphangioma successfully managed by laparoscopic partial splenectomy. The patient recovered well after operation. Laparoscopic partial splenectomy is a safe and minimally invasive technique for treatment of splenic hemolymphangioma located in the pole of the spleen.
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Affiliation(s)
| | - Xue-Min Chen
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China.
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12
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Kalogeropoulos G, Gundara JS, Samra JS, Hugh TJ. Laparoscopic stapled excision of non-parasitic splenic cysts. ANZ J Surg 2013; 85:74-9. [PMID: 23980875 DOI: 10.1111/ans.12367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND A laparoscopic spleen preserving surgical approach is preferred for the management of symptomatic non-parasitic splenic cysts. The aim of this study was to review our experience with managing this rare presentation. METHODS A retrospective review of all cases of splenic cysts was performed over a 10-year period (2001-2011). Demographic data, clinical history, investigations, operative details and the outcome of each case were reviewed with an emphasis on patients who underwent laparoscopic stapled cyst excision. RESULTS Eleven cases were identified. Seven patients were managed surgically; six by laparoscopic stapled cyst excision and one by open excision of remnant splenic tissue. Laparoscopic management was successful in all six cases and radiological and clinical follow-up (median: 28 months) revealed no evidence of cyst recurrence in five of six cases. One patient developed an asymptomatic, non-progressing and small recurrent anterior cyst and she continues to be observed. CONCLUSION Laparoscopic stapled splenic cyst excision can be performed safely and is particularly effective for large superficial non-parasitic cysts. This technique allows spleen preservation with a low cyst recurrence rate. However, it may not be suitable for deeper intraparenchymal splenic cysts. Further studies are required to refine the management of specific subtypes of non-parasitic splenic cysts.
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Affiliation(s)
- Gregory Kalogeropoulos
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia
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13
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Laparoscopic splenic cyst excision with a harmonic scalpel and glue agents in children. Asian J Surg 2012; 35:123. [PMID: 22884270 DOI: 10.1016/j.asjsur.2012.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 05/22/2011] [Accepted: 04/11/2012] [Indexed: 11/20/2022] Open
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14
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Knott EM, Valusek PA, St Peter SD. Laparoscopic excision of a giant splenic vascular tumor. J Pediatr Surg 2012; 47:E21-3. [PMID: 22813826 DOI: 10.1016/j.jpedsurg.2012.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 03/12/2012] [Accepted: 03/19/2012] [Indexed: 11/17/2022]
Abstract
The splenic vascular tumor referred to as a hemangioma is rare and typically presents as a small asymptomatic lesion. We report a case of a giant splenic cyst in a 13-year-old boy with abdominal distension. He underwent laparoscopic excision of the splenic cyst without complication. Pathology revealed a vascular tumor. At 15 months of follow-up, he continued to be asymptomatic, and abdominal ultrasound showed no recurrence of his disease. Laparoscopic excision of giant splenic cysts is a viable option in children, allowing for preservation of normal splenic tissue.
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Affiliation(s)
- E Marty Knott
- Children's Mercy Hospital and Clinics, Kansas City, MO 64108, USA
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15
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Hodge MG, Ricketts RR, Simoneaux SF, Abramowsky CR, Elawabdeh N, Shehata BM. Splenic cysts in the pediatric population: a report of 21 cases with review of the literature. Fetal Pediatr Pathol 2012; 31:54-62. [PMID: 22409406 DOI: 10.3109/15513815.2011.648725] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Splenic cysts are rare lesions that can occur in parasitic and non-parasitic forms. Because they are uncommon, the classification, pathogenesis, and management techniques are still debated. The continual review of splenic cyst cases in the pediatric population is essential for establishing a clear diagnosis and course of treatment. This report presents 21 cases of pediatric splenic cysts observed at Children's Healthcare of Atlanta over an 18 year period (1993-2011). The cases include both parasitic and and nonparasitic cysts. The current splenic cyst classification and treatment methods are analyzed through a review of the current theories and based on our experiences.
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Affiliation(s)
- M G Hodge
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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16
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Vajda P, Kereskai L, Czauderna P, Schaarschmidt K, Kalman A, Koltai J, Engelis A, Kalman E, Lewicki K, Verebely T, Jainsch M, Petersons A, Pinter AB. Re-evaluation of histological findings of nonparasitic splenic cysts. Eur J Gastroenterol Hepatol 2012; 24:316-9. [PMID: 22157248 DOI: 10.1097/meg.0b013e32834ea639] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The pathogenesis of nonparasitic splenic cysts (NPSCs) has not been clarified completely. The aim of this multinational and multicentre retrospective study was to further elucidate the origin of NPSCs. METHODS From 1980 to 2006, 50 children and adolescents were surgically treated for NPSC at six paediatric surgical centres in four European countries. The initial histology report of 35 NPSCs, 22 epidermoid cysts, 11 pseudocysts or post-traumatic cysts and two mesothelial cysts was available. Additional re-evaluation, including immunohistochemistry, to detect cytokeratin, carcino-embrionic antigen and mesothelioma antibody in the inner surface of the cysts was carried out. Special attention was given to the possibility of preceding trauma to the splenic area and whether it played a role in the genesis of NPSC. RESULTS The pathological re-evaluation showed 30 epidermoid cysts, four mesothelial cysts and one pseudocyst. Immunohistology revealed eight epidermoid and two mesothelial linings of the cysts in those 11 patients in whom pseudocyst was diagnosed originally. No pseudocyst was documented in those patients who had a history of previous blunt abdominal trauma but was not proved by ultrasound and computed tomography scan. CONCLUSION In contrast with the prevailing belief, it has been demonstrated that NPSCs are congenital in origin, and there is no clinically proven evidence that trauma does play a role in their genesis.
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Affiliation(s)
- Peter Vajda
- Department of Pediatrics, Surgical Unit, Faculty of Medicine, University of Pecs, Pecs, Hungary.
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17
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Dan D, Bascombe N, Harnanan D, Hariharan S, Naraynsingh V. Laparoscopic management of a massive splenic cyst. Asian J Surg 2011; 33:103-6. [PMID: 21029948 DOI: 10.1016/s1015-9584(10)60018-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2010] [Indexed: 10/18/2022] Open
Abstract
Splenic cysts are relatively uncommon entities in surgical practice and treatment options vary. We present a case of a young adult woman who presented with a left-sided abdominal mass. A large splenic cyst was diagnosed by abdominal ultrasound and computed tomography. Laparoscopic partial excision with marsupialisation was performed with uneventful recovery and minimal blood loss. Histopathology revealed an epidermoid cyst of the spleen. This report describes the case, and includes a short review of the literature. Laparoscopic partial excision with marsupialisation is a safe and appropriate method of treatment for large splenic cysts.
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Affiliation(s)
- Dilip Dan
- San Fernando General Hospital, West Indies, St. Augustine, Trinidad
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18
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Bong JJ, Kumar R, Spalding D. A novel technique of partial splenectomy using radiofrequency ablation. J Gastrointest Surg 2011; 15:371-2. [PMID: 20835773 DOI: 10.1007/s11605-010-1226-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 05/11/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Partial splenectomy has frequently been advocated to avoid the risk of overwhelming postsplenectomy sepsis. Concerns over adequate haemostasis during partial splenectomy, however, have limited its widespread use. We have previously reported our experience of using radiofrequency (RF) ablation to minimise blood loss during hepatic and splenic resections. METHODS In this video, we illustrate the technique of partial splenectomy assisted by RF energy to minimise blood loss.
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Affiliation(s)
- Jan Jin Bong
- Department of Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK.
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Abstracts of IPEG 2010, the 19th Annual Congress for Endosurgery in Children. June 8-12, 2010. Waikoloa, Hawaii, USA. J Laparoendosc Adv Surg Tech A 2010; 20 Suppl 1:S1-99. [PMID: 20491548 DOI: 10.1089/lap.2010.9996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Huge dermoid cyst of the spleen. Indian J Pediatr 2010; 77:454-5. [PMID: 20140765 DOI: 10.1007/s12098-010-0025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 09/06/2009] [Indexed: 10/19/2022]
Abstract
Primary splenic cysts are uncommon lesions of the spleen. Splenic cysts are classified as primary or secondary on the basis of presence or absence of an epithelial lining. The primary cysts are further subdivided as parasitic or non-parasitic. The congenital non-parasitic cysts are rarely met in clinical practice and it constitutes approximately 10% of all splenic cysts. Congenital cysts are true cysts with an epithelial. Secondary cysts are in most cases posttraumatic. Patient at admission had lower abdominal pain and splenic cyst was asymptomatic. In routine abdominal pain investigation we found cyst of the spleen in diameter 2 cm. We made serodiagnostic tests for echinococcosis which were negative. After 3 years she came with left upper quadrant enlargement with tangible abdominal mass, increasing abdominal girth, decrease of appetite and sometimes vomiting. CT scan showed cyst enlargement in diameter 8 x 6 cm. Operative treatment was necessary and splenectomy was done. However, splenectomy remains a relatively safe procedure, associated with few complications and avoiding any future problems.
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Subtotal resection and omentoplasty of the epidermoid splenic cyst: a case report. CASES JOURNAL 2009; 2:6382. [PMID: 19829799 PMCID: PMC2740323 DOI: 10.4076/1757-1626-2-6382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 07/08/2009] [Indexed: 11/08/2022]
Abstract
Introduction Nonparasitic splenic cysts are uncommon clinical entity and because of it, there is no information regarding their optimal surgical treatment. Case presentation A 41-years-old female with incidentally diagnosed nonparasitic splenic cyst which initially was asymptomatic. After two years of follow up, the patient underwent surgery; subtotal cystectomy and omentoplasty as an additional procedure. Postoperative course was uneventful. Conclusion Short and mid term results showed that near total cystectomy with omentoplasty was a safe successful procedure for treatment of epidermoid splenic cyst.
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Szczepanik AB, Meissner AJ. Partial splenectomy in the management of nonparasitic splenic cysts. World J Surg 2009; 33:852-6. [PMID: 19172349 DOI: 10.1007/s00268-008-9868-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recognition of the importance of the spleen in immunological function and the potential threat of severe postsplenectomy complications have led to the development of parenchyma-preserving surgical procedures. The aim of the present study was to assess the impact of open splenic partial resection on the management of splenic cysts. PATIENTS AND METHODS From April 2003 to June 2007, 11 patients with splenic cysts were evaluated. All patients fulfilled the criteria for surgical resection. Ten of the patients (6 women and 4 men) 15-42 years of age (mean: 26.4 years) were subjected to open partial splenectomy. In one patient, a centrally located splenic cyst was considered unsuitable for partial splenectomy, and the patient therefore underwent total spleen excision. Patients with splenic cysts constituted 3.8% of all 290 patients subjected to splenectomy during the study period. Spleen parenchyma was cut with the aid of a LigaSure instrument. Bleeding from the transected splenic parenchyma was secured with argon plasma coagulation and absorbable tape sutures or oxidized cellulose. RESULTS Nine of the ten patients underwent successful partial splenectomy. In one patient, insufficient arterial supply to the preserved splenic remnant after excision of the upper cyst-containing splenic pole led to total splenectomy. The mean operative time was 98 min (range: 85-160 min), and mean blood loss was 106 ml (55-200 ml). The mean cyst diameter was 9.1 cm (range: 7-17 cm) and weight was 738 g (range: 230-2,420 g). The postoperative course was uneventful in all cases. Pathological examination showed an epithelial cyst in 8 patients and a pseudocyst in 2. After a mean follow-up of 26.4 months, the size of the splenic remnant constituted, on average, 71% of preoperative spleen size. Moreover, normal splenic vein flow was observed. Platelet counts remained within the normal range, and no cyst recurrence was observed. There were no infections documented during the follow-up period. CONCLUSIONS Open partial splenectomy is a safe and effective method in the management of nonparasitic splenic cysts. It ensures complete cyst removal, lack of cyst recurrence, and preservation of the spleen functions.
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Affiliation(s)
- Andrzej B Szczepanik
- Department of General and Haematological Surgery, Institute of Haematology and Transfusion Medicine, 5 Chocimska Street, Warsaw, 00957, Poland.
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Gumbs AA, Bouhanna P, Bar-Zakai B, Briennon X, Gayet B. Laparoscopic partial splenectomy using radiofrequency ablation. J Laparoendosc Adv Surg Tech A 2008; 18:611-3. [PMID: 18721016 DOI: 10.1089/lap.2007.0194] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Epidermoid cysts are believed to be congenital in origin and often present in the pediatric population. Because of the concerns of compromised immunologic function after total splenectomy and increasing demand for minimally invasive approaches, interest has increased in performing the partial splenectomy in this patient population by laparoscopic techniques. Nonetheless, concerns for adequate hemostasis have limited its widespread adoption. Because radiofrequency ablation for the partial splenectomy has been done in a laparoscopic porcine model with good results, we used this technology with the goal of limiting blood loss and postoperative hemorrhagic complications. CASE REPORT A 25-year-old female presented with complaints of right shoulder pain. Abdominal ultrasound and a computed tomography (CT) scan revealed a 10-cm cystic lesion of the spleen. Serology was negative for hydatid cyst pathology. The patient underwent an uneventful partial splenectomy by minimally invasive techniques with the aid of a laparoscopic radiofrequency ablative device and the placement of a hemostatic medicated sponge along the line of transection. RESULTS Estimated blood loss was less than 30 mL. Final pathology was consistent with an epidermoid splenic cyst, and the patient was discharged uneventfully on postoperative day 5. DISCUSSION Techniques for the treatment of symptomatic splenic cysts range from total splenectomy to cyst fenestration and placement of the omentum in the splenic defect. The use of radiofrequency ablation has been traditionally used for hepatic parenchymal transection but seems equally suited for the partial splenectomy. This technology, and the addition of hemostatic sponges, seems to provide excellent results in minimizing blood loss, intraoperatively and postoperatively, during the laparoscopic partial splenectomy; however, randomized, prospective trials will be necessary to see if they will be superior to traditional techniques.
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Affiliation(s)
- Andrew A Gumbs
- Department of Medical and Surgical Digestive Diseases, Institut Mutualiste Montsouris, University Paris V, Paris, France
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Fisher JC, Gurung B, Cowles RA. Recurrence after laparoscopic excision of nonparasitic splenic cysts. J Pediatr Surg 2008; 43:1644-8. [PMID: 18779000 DOI: 10.1016/j.jpedsurg.2007.12.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 12/17/2007] [Accepted: 12/17/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND Minimally invasive treatments for nonparasitic splenic cysts are well described. Recent evidence suggests that laparoscopic splenic cystectomy is associated with high recurrence rates in children. Because these cysts are uncommon, no large series is available. We reviewed our clinical data focusing on cyst recurrences and their management. METHODS All children who underwent laparoscopic excision of a nonparasitic splenic cyst from January 2002 to December 2006 were identified. Medical and surgical records were reviewed for perioperative details, hospital course, and outcome. RESULTS Eight children (median age, 13 years; range, 7-16 years) who underwent laparoscopic splenic cystectomy were identified. The most common presenting complaint was left upper quadrant pain or mass (n = 6; 75%). Median cyst size was 13 cm (range, 4-20 cm). There were no conversions to an open technique, completion splenectomies, or perioperative complications. Cysts were identified pathologically as epidermoid (n = 6) or posttraumatic (n = 2). Median hospital stay was 1.5 days. One child required partial splenectomy because of cyst anatomy and remains recurrence-free at 12 months. Cyst recurrence occurred in 7 patients (88%) at a median of 9.4 months (range, 3-18 months) after initial surgery. Median recurrent cyst size was 5.6 cm (range, 3-11 cm). Of 7 recurrences, 4 (57%) were symptomatic. Percutaneous ultrasound-guided cyst drainage and sclerosis were performed in 2 children with symptomatic recurrences, one of whom required 4 separate interventions. There were no complications during management of cyst recurrences. Five children with recurrence (71%) have been followed conservatively and are free of morbidity at a median of 23 months (range, 8-55 months). CONCLUSIONS Laparoscopic excision of nonparasitic splenic cysts in children is associated with a high recurrence rate and may be insufficient treatment. Partial splenectomy may decrease recurrence rates. Conservative management of splenic cyst recurrence after laparoscopic excision is associated with good short-term outcomes. If necessary, image-guided management of symptomatic recurrences can be performed safely.
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Affiliation(s)
- Jason C Fisher
- Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, New York, NY 10032, USA
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Submucosal mass. J Pediatr Gastroenterol Nutr 2008; 47:1-2. [PMID: 18607261 DOI: 10.1097/mpg.0b013e3181770276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2008; 22:821-48. [PMID: 18293036 DOI: 10.1007/s00464-007-9735-5] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 11/23/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases, some areas still remain controversial. To date, the indications that preclude laparoscopic splenectomy are not clearly defined. In view of this, the European Association for Endoscopic Surgery (EAES) has developed clinical practice guidelines for LS. METHODS An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. A consensus development conference using a nominal group process convened in May 2007. Its recommendations were presented at the annual EAES congress in Athens, Greece, on 5 July 2007 for discussion and further input. After a further Delphi process between the experts, the final recommendations were agreed upon. RESULTS Laparoscopic splenectomy is indicated for most benign and malignant hematologic diseases independently of the patient's age and body weight. Preoperative investigation is recommended for obtaining information on spleen size and volume as well as the presence of accessory splenic tissue. Preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections is recommended in elective cases. Perioperative anticoagulant prophylaxis with subcutaneous heparin should be administered to all patients and prolonged anticoagulant prophylaxis to high-risk patients. The choice of approach (supine [anterior], semilateral or lateral) is left to the surgeon's preference and concomitant conditions. In cases of massive splenomegaly, the hand-assisted technique should be considered to avoid conversion to open surgery and to reduce complication rates. The expert panel still considered portal hypertension and major medical comorbidities as contraindications to LS. CONCLUSION Despite a lack of level 1 evidence, LS is a safe and advantageous procedure in experienced hands that has displaced open surgery for almost all indications. To support the clinical evidence, further randomized controlled trials on different issues are mandatory.
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Affiliation(s)
- B Habermalz
- Institute for Research in Operative Medicine, University Witten/Herdecke, Witten/Herdecke, IFOM, Ostmerheimer Strasse 200, 51109, Köln, Germany
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Abstract
PURPOSE Laparoscopic unroofing is described as an appropriate treatment modality of nonparasitic splenic cysts. However, we repeatedly encountered recurrences with this technique. Because splenic cysts are rare, we analyzed the combined experience of 3 German pediatric surgical departments. MATERIALS AND METHODS Between 1995 and 2005, primary and secondary nonparasitic splenic cysts were unroofed laparoscopically in 14 children (aged 5-12 years; median, 8.5 years). In 3 patients, the inner surface was coagulated with the argon beamer. In most children, the cavity was surfaced with omentum. In addition, in 4 patients the omentum was sutured to the splenic parenchyma. RESULTS No intraoperative complications occurred, and no inadvertent splenectomy or blood transfusions were necessary. However, in 9 children (64%) the cysts recurred at intervals ranging from 6 to 12 months (median, 12 months). Also, argon laser treatment of the surface resulted in recurrence. CONCLUSION Laparoscopic unroofing of true splenic cysts alone proved inadequate in this series. Either removal of the inner layer or partial splenectomy appears to be necessary to prevent recurrences.
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Affiliation(s)
- Felix Schier
- Department of Pediatric Surgery, University Medical Centres, Mainz 55101, Germany.
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