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Tiutiuca RC, Nastase Puscasu AI, Stoenescu N, Moscalu M, Bradea C, Eva I, Lupascu CD, Ivan L, Palaghia MM, Prisecariu DI, Târcoveanu E, Vâță A, Bejan V, Vasilescu AM. Laparoscopic Approach to Primary Splenic Cyst: Case Report and Review of the Literature. Life (Basel) 2024; 14:120. [PMID: 38255735 PMCID: PMC10817520 DOI: 10.3390/life14010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/27/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Splenic cysts are rare benign lesions of the spleen, often asymptomatic and incidentally discovered during imaging studies. While many splenic cysts remain asymptomatic and do not require intervention, surgical management becomes essential in cases of symptomatic cysts, large cysts, or when malignancy cannot be ruled out. Laparoscopic surgery has emerged as a minimally invasive and effective approach for treating splenic cysts, offering advantages such as shorter hospital stays, reduced postoperative pain, and faster recovery. In this case report, we describe our experience with laparoscopic surgery for a symptomatic splenic cyst in a young patient.
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Affiliation(s)
- Razvan Calin Tiutiuca
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | | | - Nicoleta Stoenescu
- Faculty of Psychology and Education Sciences, “Alexandru Ioan Cuza” University of Iași, 700506 Iasi, Romania
| | - Mihaela Moscalu
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Costel Bradea
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Iuliana Eva
- Radiology Department, “Dr Iacob Czihac” Military Emergency Hospital of Iași, 700483 Iasi, Romania
| | - Cristian Dumitru Lupascu
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Luminita Ivan
- Pathology Department, “Dr Iacob Czihac” Military Emergency Hospital of Iași, 700483 Iasi, Romania
| | - Madalina Maria Palaghia
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Denisa Ioana Prisecariu
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Eugen Târcoveanu
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Andrei Vâță
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Valentin Bejan
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Alin Mihai Vasilescu
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
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Ott KC, Scorletti F, Alhajjat AM, Green JR, Shaaban AF. Nonparasitic Splenic Cysts in Children: Outcomes after Sclerotherapy or Surgical Resection as Initial Management. J Vasc Interv Radiol 2023; 34:1822-1826. [PMID: 37327944 DOI: 10.1016/j.jvir.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 05/18/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023] Open
Abstract
Management of splenic cysts in children remains undefined. Sclerotherapy is an innovative, less invasive treatment. This study examined the safety and preliminary effectiveness of sclerotherapy for splenic cysts in children compared with those of surgical treatment. A retrospective review of pediatric patients treated for nonparasitic splenic cysts from 2007 to 2021 was performed at a single institution. Posttreatment outcomes for patients who underwent either expectant management, sclerotherapy, or surgery were reviewed. Thirty patients aged between 0 and 18 years met the inclusion criteria. Cysts in 3 of 8 patients who underwent sclerotherapy were either unresolved or recurred. Patients who underwent sclerotherapy and required surgery for residual symptomatic cyst had an initial cyst diameter of >8 cm. Symptoms resolved in 5 of 8 patients who underwent sclerotherapy, with a significantly reduced cyst size compared with that in patients with continued symptoms who underwent sclerotherapy (61.4% vs 7.0%, P = .01). Sclerotherapy is an effective treatment for splenic cysts, particularly those measuring <8 cm. However, surgical excision may be preferable for large cysts.
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Affiliation(s)
- Katherine C Ott
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Federico Scorletti
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amir M Alhajjat
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jared R Green
- Division of Interventional Radiology, Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Aimen F Shaaban
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Fujikawa H, Hinata M. Splenic incidentaloma on routine chest radiography before admission to a nursing home. BMJ Case Rep 2021; 14:e243031. [PMID: 33795264 PMCID: PMC8023746 DOI: 10.1136/bcr-2021-243031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Hirohisa Fujikawa
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Internal Medicine, You Home Clinic, Bunkyo-ku, Tokyo, Japan
| | - Michiko Hinata
- Department of Internal Medicine, You Home Clinic, Bunkyo-ku, Tokyo, Japan
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A splenic cyst causing a viscerosomatic reflex in the thoracic spine. A case report. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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5
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Manciu S, Tudor S, Vasilescu C. Splenic Cysts: A Strong Indication for a Minimally Invasive Partial Splenectomy. Could the Splenic Hilar Vasculature Type Hold a Defining Role? World J Surg 2018; 42:3543-3550. [PMID: 29717347 DOI: 10.1007/s00268-018-4650-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of the study is to assess the impact of the splenic hilar vasculature configuration on the amount of remnant splenic parenchyma volume after partial splenectomy for splenic cysts. METHODS The data of all patients receiving a splenectomy for a splenic cyst from 2002 to 2016 at the Center of General Surgery and Liver Transplantation of Fundeni Clinical Institute were retrospectively reviewed. The size and location in the splenic parenchyma of the cyst and the splenic hilar vasculature type were assessed for each patient with a splenectomy. RESULTS Thirty-one patients with non-parasitic and 32 patients with hydatid cysts were recorded. In cases of centrally located cysts, a total splenectomy was performed for the majority of cases, while in peripheral cysts a spleen-preserving surgery was feasible for most of the patients (p = 0.001). The size of the cyst was significantly higher in the group of patients with a total splenectomy, compared with the group with a partial splenectomy (p = 0.003). In the subgroup with a distributed arterial pattern, preservation of more than 50% of the initial parenchyma was achieved in a significantly higher proportion of patients, compared with the subgroup of patients with a magistral pattern (p = 0.012). CONCLUSION Besides cyst size or peripheral location in the splenic parenchyma, the vascular pattern is also considered another decisive factor that associates with successful conservative or minimally invasive approach.
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Affiliation(s)
- Simona Manciu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Stefan Tudor
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, Bucharest, Romania
| | - Catalin Vasilescu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, Bucharest, Romania.
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
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Yuksel UM, Turanli S, Berberoglu AU, Gulben K. Management of Incidentally Diagnosed Splenic Masses. Indian J Surg 2018. [DOI: 10.1007/s12262-016-1582-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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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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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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de la Villeon B, Zarzavadjian Le Bian A, Vuarnesson H, Munoz Bongrand N, Halimi B, Sarfati E, Cattan P, Chirica M. Laparoscopic partial splenectomy: a technical tip. Surg Endosc 2014; 29:94-9. [DOI: 10.1007/s00464-014-3638-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/16/2014] [Indexed: 01/25/2023]
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Varban O. Splenic cyst during pregnancy. Int J Surg Case Rep 2014; 5:315-8. [PMID: 24794024 PMCID: PMC4066563 DOI: 10.1016/j.ijscr.2014.03.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 03/21/2014] [Accepted: 03/26/2014] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Splenic cyst during pregnancy is rare and may result in spontaneous rupture during the third trimester, which increases perinatal morality. PRESENTATION OF CASE We present a 27-year-old healthy Caucasian female who presented at 18 weeks gestation with left flank pain, early satiety and weight loss. Imaging studies demonstrated a large complex multiloculated splenic cyst. The patient underwent a successful laparoscopic splenectomy and delivered a healthy child at term without complication. DISCUSSION Spontaneous rupture of a splenic cyst during the third trimester incurs a perinatal mortality rate as high as 70%. Surgical management includes open or laparoscopic splenectomy or fenestration and preservation of the spleen. CONCLUSION Laparoscopic splenectomy during the second trimester appears to be safe and offers definitive management of a large symptomatic splenic cyst during pregnancy.
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Affiliation(s)
- Oliver Varban
- University of Michigan Health Systems, 2210 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI 48109-5343, United States.
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11
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Zvizdić Z, Karavdić K. Spleen-preserving surgery in treatment of large mesothelial splenic cyst in children--a case report and review of the literature. Bosn J Basic Med Sci 2014; 13:126-8. [PMID: 23725510 DOI: 10.17305/bjbms.2013.2395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The nonparasitic primary splenic cysts are very rare clinical entity. In the past, splenectomy was the treatment of choice but with the recognition of the spleen's important immunological function, spleen-preserving surgery is the preferred treatment modality. We hereby present a case of a large splenic mesothelial cyst and its treatment with preservation of the remaining splenic parenchyma. Our case shows that spleen-preserving surgery in treatment of the large splenic cysts is possible and safe procedure with maintenance of the splenic function.
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Affiliation(s)
- Zlatan Zvizdić
- Clinic of Pediatric Surgery, Clinical Centre of Sarajevo University, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina.
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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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Sharma S, Sharma K, Jain A. Epithelial cyst of the spleen-a rare presentation. Indian J Surg 2013; 75:210-1. [PMID: 24426567 PMCID: PMC3693299 DOI: 10.1007/s12262-012-0630-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 06/12/2012] [Indexed: 10/28/2022] Open
Abstract
Splenic cysts are rare and epithelial cysts are still rarer. Symptoms emerge because of enlargement, infection, hemorrhage, or ruptures. Traditionally, splenectomy was the treatment of choice. However, with the recognition of the important immunological function of the spleen, preservation procedures such as partial splenectomy or total splenectomy with splenorrhaphy have been increasingly used during the past decade. We report a case of a 23-year-old woman presented with left hypochondrial pain and feeling of lump.
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Affiliation(s)
- Somnath Sharma
- Department of Surgery and Pathology, S.M.S. Medical College, 16, Mahar House, Gangapole Road, Jorawar Singh Gate, Jaipur, India
| | - Kalpana Sharma
- Department of Surgery and Pathology, S.M.S. Medical College, 16, Mahar House, Gangapole Road, Jorawar Singh Gate, Jaipur, India
| | - Ayushi Jain
- Department of Surgery and Pathology, S.M.S. Medical College, 16, Mahar House, Gangapole Road, Jorawar Singh Gate, Jaipur, India
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Abstract
We report the case of a patient with a palpable mass and abdominal pain in the left upper quadrant. A physical examination revealed tenderness in this region. An ultrasound performed initially showed a large cystic structure. A CT examination revealed a large cyst originating in the spleen with loculations in its upper part and focal calcification in the wall. On MRI, the cystic mass showed high signal on T1-weighted and T2-weighted images. The carbohydrate antigen 19-9 (CA 19-9) was measured at 88 U/ml (standard <37.1 mUI/l). According to the imaging examinations and laboratory tests performed, it was impossible to determine if the splenic cyst was parasitic or non-parasitic. Given the most important risks of complications encountered in parasitic cysts, it was decided to treat this splenic cyst as a parasitic cyst. For this reason, an elective laparoscopic splenectomy with preoperative embolisation of the splenic artery was performed. The histological diagnosis was a primary epidermoid splenic cyst with inner lining epithelial cells.
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Affiliation(s)
- Quoc Duy Vo
- Department of Radiology, HFR Fribourg, Fribourg, Switzerland.
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Yoh T, Wada S, Kobayashi A, Nakamura Y, Kato T, Nakayama H, Okamura R. Laparoscopic splenectomy for a large multilocular splenic cyst with elevated CA19-9: Report of a case. Int J Surg Case Rep 2013; 4:319-21. [PMID: 23399517 DOI: 10.1016/j.ijscr.2013.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 12/18/2012] [Accepted: 01/02/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Because splenic cysts are rare, a definitive treatment regime for these cysts remains unclear. We report a case of a large multilocular splenic cyst with elevated carbohydrate antigen 19-9 (CA19-9) levels, which was successfully treated with laparoscopic splenectomy. PRESENTATION OF CASE A 22-year-old female was admitted to our hospital with severe left upper abdominal pain. Serum CA19-9 level was mildly elevated (65U/ml). Computed tomography revealed a 25-cm long spleen with multilocular cystic lesions, for which an emergency laparoscopic splenectomy was performed. Histological findings revealed that the lesion was a benign true cyst, and immunostaining analyses showed that the epithelium was CA19-9-positive. DISCUSSION Although some spleen-preserving approaches have been reportedly used, splenic cyst recurrence usually occurs in true cyst cases, wherein the cyst is incompletely removed. Most reported cases of splenic cysts producing CA19-9 are true cysts. CONCLUSION The treatment approach should be decided on the basis of the type, shape, location, and even CA19-9 levels of the splenic cyst.
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Affiliation(s)
- Tomoaki Yoh
- Department of surgery Yamatotakada municipal hospital, Nara, Japan.
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Abstract
UNLABELLED Splenic cysts are rarely diagnosed lesions. This also includes splenic pseudocysts, which usually develop as a result of a blunt abdominal cavity injury. Splenic cysts are usually diagnosed on the basis of imaging examinations, performed in case of symptomatic patients or those subject to a blunt abdominal cavity injury. MATERIAL AND METHODS The study group comprised six patients with a positive history of blunt abdominal cavity trauma, verified by means of histopathological examinations, which were subject to surgical intervention at the Department of General and Endocrinological Surgery, Medical University in Łódź, during the period between 01.01.2006 and 31.12.2010. Before or during the surgical procedure cystic lesions were diagnosed. The efficacy of the surgical intervention was determined. RESULTS Splenic pseudocysts were diagnosed in only two of the patients, although in all there was a reasonable suspicion of the above-mentioned lesion. One patient required three operations, due to recurrence of the lesion, which proved to be a primary epithelial cyst. Two of the patients required early explorative relaparotomy. Apart from the above-mentioned, treatment proved uneventful. CONCLUSIONS The diagnosis of a splenic pseudocyst is established in case of suspicion of the above-mentioned lesion. This is evidence that in some patients focal lesions of a different nature are present, being detected by means of diagnostic imaging examinations performed after abdominal cavity injuries.
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Huang SC, Chang YY, Chao YJ, Shan YS, Lin XZ, Lee GB. Dual-row needle arrays under an electromagnetic thermotherapy system for bloodless liver resection surgery. IEEE Trans Biomed Eng 2011; 59:824-31. [PMID: 22194233 DOI: 10.1109/tbme.2011.2180381] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Electromagnetic thermotherapy has been extensively investigated recently and may become a new surgical modality for a variety of medical applications. It applies a high-frequency alternating magnetic field to heat up magnetic materials inserted within the human body to generate tissue coagulation or cell apoptosis. Using a new procedure with dual-row needle arrays under an electromagnetic thermotherapy system with a feedback temperature control system, this study demonstrates bloodless porcine liver resection, which is challenging using existing methods. In vitro experiments showed that hollowed, stainless-steel needles could be heated up to more than 300 °C within 30 s when centered under the induction coils of the electromagnetic thermotherapy system. In order to generate a wide ablation zone and to prevent the dual-row needle arrays from sticking to the tissue after heating, a constant temperature of 120 °C was applied using a specific treatment protocol. The temperature distribution in the porcine livers was also measured to explore the effective coagulation area. Liver resection was then performed in Lan-Yu pigs. Experimental results showed that seven pigs underwent liver resection without bleeding during surgery and no complications afterward. The dual-row needle arrays combined with the electromagnetic thermotherapy system are thus shown to be promising for bloodless tissue resection.
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Affiliation(s)
- Sheng Chieh Huang
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan.
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18
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Stoidis CN, Spyropoulos BG, Misiakos EP, Fountzilas CK, Paraskeva PP, Fotiadis CI. Spontaneous regression of a true splenic cyst: a case report and review of the literature. CASES JOURNAL 2009; 2:8730. [PMID: 20184691 DOI: 10.1186/1757-1626-0002-0000008730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 08/31/2009] [Indexed: 12/18/2022]
Abstract
Splenic cysts are rare clinical findings, detected due to derivative symptoms or as a random discovery in abdominal imaging. Although there still remains controversy as to their optimal treatment, bigger secondary cysts should be treated surgically. However, spontaneous regression may be observed in cysts with a diameter smaller than 4 cm. In these cases, expectant treatment is preferable. We report, herein, a single case of a splenic cyst in an adult woman, who reported minor symptoms despite the size of the lesion and who demonstrated a possible almost total regression of the cyst within a ten-year period, accompanying with review of the most recent literature.
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Affiliation(s)
- Christos N Stoidis
- 3rd Department of Surgery, University of Athens Medical School, Attikon University Hospital, 1 Rimini Street, Chaidari, 12462, Greece.
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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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Adas G, Karatepe O, Altiok M, Battal M, Bender O, Ozcan D, Karahan S. Diagnostic problems with parasitic and non-parasitic splenic cysts. BMC Surg 2009; 9:9. [PMID: 19476658 PMCID: PMC2701920 DOI: 10.1186/1471-2482-9-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 05/29/2009] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The splenic cysts constitute a very rare clinical entity. They may occur secondary to trauma or even being more seldom due to parasitic infestations, mainly caused by ecchinocccus granulosus. Literature lacks a defined concencus including the treatment plans and follow up strategies, nor long term results of the patients. In the current study, we aimed to evaluate the diagnosis, management of patients with parasitic and non-parasitic splenic cysts together with their long term follow up progresses. METHODS Twenty-four patients with splenic cysts have undergone surgery in our department over the last 9 years. Data from eighteen of the twenty-four patients were collected prospectively, while data from six were retrospectively collected. All patients were assessed in terms of age, gender, hospital stay, preoperative diagnosis, additional disease, serology, ultrasonography, computed tomography (CT), cyst recurrences and treatment. RESULTS In this study, the majority of patients presented with abdominal discomfort and palpable swelling in the left hypochondrium. All patients were operated on electively. The patients included 14 female and 10 male patients, with a mean age of 44.77 years (range 20-62). Splenic hydatid cysts were present in 16 patients, one of whom also had liver hydatid cysts (6.25%). Four other patients were operated on for a simple cyst (16%) two patients for an epithelial cyst, and the last two for splenic lymphangioma. Of the 16 patients diagnosed as having splenic hydatit cysts, 11 (68.7%) were correctly diagnosed. Only two of these patients were administered benzimidazole therapy pre-operatively because of the risk of multicystic disease The mean follow-up period was 64 months (6-108). There were no recurrences of splenic cysts. CONCLUSION Surgeons should keep in mind the possibility of a parasitic cyst when no definitive alternative diagnosis can be made. In the treatment of splenic hydatidosis, benzimidazole therapy is not necessary, although it is crucial to perform splenectomy without rupturing and spilling the cysts.
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Affiliation(s)
- Gokhan Adas
- Okmeydani Training and Research Hospital, Department of General Surgery, Istanbul, Turkey.
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Ramia Angel JM, de la Plaza Llamas R, Veguillas Redondo P, Quiñones Sampedro JE, García-Parreño Jofré J. [Laparoscopic splenectomy as treatment of a post-traumatic splenic cyst]. Cir Esp 2009; 86:259-61. [PMID: 19439278 DOI: 10.1016/j.ciresp.2008.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 07/28/2008] [Indexed: 11/29/2022]
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22
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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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23
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Laparoscopic internal marsupializaton for large nonparasitic splenic cysts: effective organ-preserving technique. World J Surg 2008; 32:20-5. [PMID: 17990026 DOI: 10.1007/s00268-007-9258-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary splenic cyst is a rare disease, and therefore there is no information regarding its optimal management. Most such cysts are classified as epithelial cysts. During the last few years, the laparoscopic approach has gained increasing acceptance in splenic surgery. We present our experience with the laparoscopic (organ-preserving) management of splenic cysts. METHODS We managed 11 patients with large symptomatic nonparasitic splenic cysts from 1996 to 2006. All the patients had fullness in the left upper abdomen and a palpable mass. Preoperative diagnosis was established with ultrasonography and computed tomography. All patients were treated with either laparoscopic partial cystectomy or marsupialization. RESULTS Seven patients had mesothelial cysts, two had epidermoid cysts, and two had pseudocysts. Nine patients did not have any problems or recurrence during an average follow-up of 29.5 months. Two patients had cyst recurrence after 14 months. CONCLUSION Laparoscopic organ-preserving surgery should be the goal of therapy in most cases. Total splenectomy is reserved for cases in which cyst excision cannot be done or most of the splenic tissue is replaced by the cyst. Plication of the cyst wall edges prevents the cyst walls from adhering and causing recurrence, as well as helping to control hemorrhage. Laparoscopic partial cystectomy/marsupialization is an acceptable procedure for the treatment of splenic cysts; and after short to mid-term follow-up, it seems that a reasonable rate of success is possible.
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24
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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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25
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Godiris-Petit G, Goasguen N, Munoz-Bongrand N, Cattan P, Sarfati E. Splénectomie partielle par laparoscopie et ultracision©. ACTA ACUST UNITED AC 2007; 144:339-41. [DOI: 10.1016/s0021-7697(07)91966-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Mezquita S, Rosado R, Gallardo A, Huertas F, Medina P, Ramírez D. Partial Laparoscopic Decapsulation of Splenic Cysts. Surg Laparosc Endosc Percutan Tech 2007; 17:49-51. [PMID: 17318056 DOI: 10.1097/01.sle.0000213755.76761.6c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the role of laparoscopic decapsulation in the management of splenic cysts. Cystic disease of spleen is an infrequent entity. Laparoscopic surgery should be considered as the method of choice for the greater of patients diagnosed with a splenic cyst. We provide 2 new cases of splenic cysts treated with partial laparoscopic decapsulation using harmonic scalpel. The patients were examined 5 years later and no cysts recurrence was found.
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Affiliation(s)
- Susana Mezquita
- Hospital del SAS de Huércal-Overa, Servicio de Cirugía, Spain
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27
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Mertens J, Penninckx F, DeWever I, Topal B. Long-term outcome after surgical treatment of nonparasitic splenic cysts. Surg Endosc 2006; 21:206-8. [PMID: 17131049 DOI: 10.1007/s00464-005-0039-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2005] [Accepted: 12/21/2005] [Indexed: 12/22/2022]
Abstract
BACKGROUND The optimal treatment for patients with nonparasitic splenic cysts is controversial. This study aimed to evaluate the clinical outcome of patients treated for a symptomatic splenic cyst, and to define a surgical strategy. METHODS Spleen-preserving surgery (9 laparotomies and 6 laparoscopies) was performed for a primary cyst in six patients and a secondary cyst in nine patients. The median follow-up time was 37.5 months. Partial splenic resection was performed for eight patients and cyst decapsulation for seven patients. RESULTS Cyst recurrence was observed in four patients after decapsulation of a primary splenic cyst, as compared with none after resection. Postoperative complications were encountered only after laparotomy (5/9). The median hospital stay was 3.5 days (range, 2-5 days) after laparoscopy, as compared with 9 days (range, 5-14 days) after laparotomy. CONCLUSIONS Symptomatic splenic cysts should be treated laparoscopically. For patients with recurrent or suspected primary splenic cysts, laparoscopic partial splenectomy is preferable. For other cases, a laparoscopic decapsulation is advocated.
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Affiliation(s)
- J Mertens
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium
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28
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Dutta S, Price VE, Blanchette V, Langer JC. A laparoscopic approach to partial splenectomy for children with hereditary spherocytosis. Surg Endosc 2006; 20:1719-24. [PMID: 17024531 DOI: 10.1007/s00464-006-0131-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 04/27/2006] [Indexed: 02/06/2023]
Abstract
BACKGROUND Partial splenectomy is sometimes used for children with hereditary spherocytosis (HS) to reduce hemolysis while retaining some splenic immune function. Previous reports have described a partial splenic resection through a laparotomy incision. Whereas laparoscopic total splenectomy for HS is well-established, laparoscopic partial splenectomy (LPS) has not been described. The authors have developed a novel LPS technique that combines the benefits of partial splenectomy with those of a laparoscopic approach. METHODS A chart review was conducted for three children with HS who underwent LPS, with approximately one-fourth of the spleen left on the basis of the short gastric arterial supply. RESULTS The mean preoperative spleen size was 17.6 cm. The mean preoperative hemoglobin count was 100 g/l, and the postoperative hemoglobin count was 133 g/l. All three patients reported reduced malaise and increased energy levels. There was no recurrent anemia at the 1- to 2-year follow-up evaluation. CONCLUSION The LPS procedure is a safe and effective approach to HS that resolves anemia, potentially retains some splenic immunity, and confers the benefits of a minimal access technique.
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Affiliation(s)
- S Dutta
- Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
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29
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Karasakalides A, Ganas E, Triantafillidou S, Lagonidis D, Papapavlou L, Nakos G. Spontaneous rupture of a true splenic cyst diagnosed by laparoscopy. Dig Dis Sci 2006; 51:1829-32. [PMID: 16964545 DOI: 10.1007/s10620-006-9076-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Accepted: 09/26/2005] [Indexed: 12/09/2022]
Affiliation(s)
- A Karasakalides
- Department of Surgery/ICU, Giannitsa General Hospital, Terma Semertzidis, Giannitsa 58100, Greece.
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30
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Rotas M, Ossowski R, Lutchman G, Levgur M. Pregnancy complicated with a giant splenic cyst: a case report and review of the literature. Arch Gynecol Obstet 2006; 275:301-5. [PMID: 16937120 DOI: 10.1007/s00404-006-0229-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Accepted: 07/27/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Splenic cysts or masses in pregnancy are extremely rare and only five cases were described in the literature. We present the first case of splenic cyst in pregnancy treated laparoscopically with fenestration and preservation of the spleen. CASE A 23-year-old primigravida at 9 weeks of gestation presented for her prenatal follow-up with a 3 weeks history of epigastric pain and early satiety. A magnetic resonance imaging of the abdomen and pelvis demonstrated a gigantic splenic cyst measuring 17 x 13 x 15 cm. Aspiration of the cyst was performed under ultrasound guidance for diagnostic purposes as well as for relief of patient's symptoms. The patient was followed by bi-weekly sonographic scan until the second trimester. A second aspiration of the cyst was complicated with sepsis, and laparoscopic fenestration and omentopexy were performed. The patient's remaining antepartum course was uncomplicated and she had a normal spontaneous delivery at thirty-eighth week. CONCLUSION The most feared complication of a splenic cyst in pregnancy is spontaneous rupture, which in the third trimester is associated with a perinatal mortality rate as high as 70%. Surgical therapy should therefore be provided in the second trimester. Laparoscopic fenestration with omentopexy is a minimally invasive, effective and safe procedure for this condition.
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Affiliation(s)
- Michael Rotas
- Department of Obstetrics and Gynecology, Maimonides Medical Center, 967 48th Street, Brooklyn, NY, USA.
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31
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Pinder RM, Thomas R, Lyndon PJ, Chapple KS. Nonelevation of Serum CA 19-9 Level in a True NonParasitic Splenic Cyst. Surg Laparosc Endosc Percutan Tech 2006; 16:190-4. [PMID: 16804468 DOI: 10.1097/00129689-200606000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The diagnosis and management of true nonparasitic splenic cysts has markedly changed in recent years. The use of serum CA 19-9 has been increasingly advocated for diagnosis, while the advent of minimally invasive surgery has radically altered surgical management. We present the first case of a true nonparasitic splenic cyst in which serum CA 19-9 was not elevated. Treatment was by laparoscopic cyst decapsulation utilising the endoscopic Ligasure.
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Affiliation(s)
- Richard M Pinder
- Department of Surgery, Dewsbury and District Hospital, Mid-Yorkshire NHS Trust, Halifax Road, Dewsbury, West Yorkshire, WF13 4HS.
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32
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Bellows CF, Sweeney JF. Laparoscopic splenectomy: present status and future perspective. Expert Rev Med Devices 2006; 3:95-104. [PMID: 16359256 DOI: 10.1586/17434440.3.1.95] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Laparoscopic splenectomy has become widely accepted as the approach of choice for the surgical treatment of benign and malignant hematologic diseases. Advances in technology have led to better outcomes for the procedure, and have allowed surgeons to apply the technique to disease processes that were at one time felt to be contraindications to laparoscopic splenectomy. However, challenges still remain. There is a steep learning curve associated with the procedure. The development of cost-effective laparoscopic simulators to target the skills required for laparoscopic splenectomy and other laparoscopic procedures is essential. The advent of devices which isolate and seal the large blood vessels that surround the spleen have reduced intra-operative bleeding and minimized conversions to open splenectomy. Improvements in optics and instrumentation, as well as robotic technology, will continue to define the frontier of minimally invasive surgery, and further facilitate the acceptance of laparoscopic splenectomy for the treatment of benign and malignant hematologic diseases.
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Affiliation(s)
- Charles F Bellows
- Baylor College of Medicine, Michael E DeBakey VAMC, Department of Surgery, Houston, TX 77030, USA.
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33
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Robertson FM, Doski JJ, Cofer BR, Kidd JN. Laparoscopic Splenic Cystectomy: A Rational Approach. ACTA ACUST UNITED AC 2004. [DOI: 10.1089/pei.2004.8.321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | - John J. Doski
- San Antonio Pediatric Surgery Associates, San Antonio, Texas
| | - Barry R. Cofer
- San Antonio Pediatric Surgery Associates, San Antonio, Texas
| | - Joseph N. Kidd
- San Antonio Pediatric Surgery Associates, San Antonio, Texas
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Edwin B, Skattum X, Rãder J, Trondsen E, Buanes T. Outpatient laparoscopic splenectomy: patient safety and satisfaction. Surg Endosc 2004; 18:1331-4. [PMID: 15803231 DOI: 10.1007/s00464-003-9174-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Accepted: 01/10/2004] [Indexed: 02/08/2023]
Abstract
BACKGROUND We assessed the feasibility of outpatient laparoscopic splenectomy, as performed by an experienced laparoscopic term and combined with optimal anesthesia. METHODS Inclusion criteria in the study was limited to patients not hospitalized before the procedure who had hematological or neoplastic indications for splenectomy and were classified as American Society of Anesthesiologists (ASA) I-III. They received general intravenous anesthesia with propofol and remifentanil and were given keterolac, propacetamol, droperidol, and ondansetron as prophylaxis against postoperative pain and nausea. Laparoscopic splenectomy was performed via three trocars. The specimen was removed via an incision in the left iliac fossa. RESULTS Ten of the 12 patients were discharged 3-6 h postoperatively; the other two were admitted primarily to hospital. One was readmitted due to a fever, which was finally explained by measles. The median operative times was 58 min (range, 45-135). Patient satisfaction was excellent in nine and intermediate in two cases; it was poor in one case, due to postoperative pain. CONCLUSION Laparoscopic splenectomy can be completed in a relatively short time; therefore, it is feasible, safe, and satisfactory for most patients as an outpatient procedure.
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Affiliation(s)
- B Edwin
- Interventional Center, National Hospital, 0407, Oslo, Norway
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