Hand-assisted laparoscopic splenectomy for a huge splenic cyst: operative technique and case report

Epidermoid cyst of the spleen

BACKGROUND

The aim of this study is to elucidate the characteristics, clinical presentations, and management of epidermoid cysts located in the spleen and the intrapancreatic accessory spleen.

METHODS

Data pooled for analysis were collected from epidermoid cyst cases encountered in the study institution and sporadic case reports obtained from the English literature.

RESULTS

There were 115 cases of epidermoid cyst. Seventy eight (67.8 %) were found in the spleen, whereas 37 (32.2 %) were found in the intrapancreatic accessory spleen. Comparing between the two groups, the splenic group showed female predominance, younger age, and larger cystic size. For symptoms, left upper abdominal mass (57.7 %) and left upper abdominal pain (39.0 %) were more commonly found in the spleen group. Meanwhile, the intrapancreatic accessory spleen group had higher percentage of asymptomatic cysts (59.5 %). As for surgical indication, majority of patients in the spleen group underwent surgery for symptomatic relief (75.4 %), while the intrapancreatic accessory spleen group underwent surgery mainly for suspicious malignancy (90.0 %).

CONCLUSIONS

Surgical treatment for epidermoid cysts of the spleen is considered the optimal treatment for either alleviating the symptoms caused by a bulky cyst or for determining the histopathologic nature of a suspicious malignant cystic neoplasm.

Laparoscopic management of a massive splenic cyst

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.

A novel therapeutic approach to non‐parasitic splenic cysts: Laparoscopic fenestration and endothelium obliteration

Splenic cyst is a relatively rare disease; true splenic cysts are classified as parasitic and non-parasitic cysts. Although most cysts are asymptomatic, large cyst cases show clinical symptoms, consisting mainly of dyspepsia and fullness in the upper left abdomen. Surgical intervention is recommended primarily for large cysts to prevent complications such as rupture, hemorrhage, and infection. This paper presents our experience of eleven laparoscopic procedures for non-parasitic splenic cysts. Laparoscopic fenestration was performed in all cases, and the cyst endothelium was destroyed . All operations were accomplished successfully. The mean operative time was 56 minutes (range 40-90 minutes). Intraoperative bleeding was 15 ml (range 5-30 ml), oral food intake was started on the first postoperative day. The median duration of postoperative hospitalization was 2.8 days (range 1-7 days). There were no postoperative complications. All cases were followed up for a period of 21 months to 5.5 years, and no recurrence occurred. Laparoscopic fenestration and endothelium obliteration is an advantageous approach to large non-parasitic splenic cysts with little postoperative pain, fast recovery, splenic tissue and splenism preservation, low complication rates, and a short hospital stay; it is easily accepted by patients. It yields favorable medium-term results. Our study confirms that good results can be achieved with an approach of laparoscopic fenestration and endothelium obliteration for simple non-parasitic splenic cysts.