Laparoscopic technique as a method of choice in the treatment of non-parasitic splenic cysts

Abstract

Introduction/Objective Splenic cysts are a rare clinical entity. In their origin, they may be parasitic or non-parasitic. They are classified as either primary (true) or secondary cysts (pseudocysts), depending on the presence or absence of an epithelial lining of the lumen. Methods Using a retrospective case study, we included 29 patients undergoing laparoscopic surgery due to splenic cysts. The patients were treated within the 2007-2017 period at the Clinic for Digestive Surgery, the Clinical Center of Serbia. We analyzed pre-operative, intra-operative and post-operative characteristics of laparoscopic technique in treating non-parasitic splenic cysts. Results The group of 29 patients treated with laparoscopic technique surgery due to the previously diagnosed splenic cyst, consisted of 12 (41.4%) men and 17 (58.6%) women. The average age of patients undergoing surgery was 38.86 ± 10.4 years (22-62). Based on the histopathological findings, there were eight epithelial cysts and 21 pseudocysts of the spleen. The maximal diameter of the splenic cyst, measured pre-operatively, was 10.09 ± 2.51 cm on average. The average operative time was 35 minutes, and the intra-operative bleeding amount was 11.48 ± 3.78 ml. None of the intra-operative complications, injury to the spleen or other organs of the abdomen, conversions to open surgery or reintervention were recorded. Conclusion Laparoscopic fenestration with excision of the part of the spleen cyst wall (marsupialization) represents an effective and definitive treatment for this disease. It is an alternative to splenectomy, along with other well-known benefits ensured by the spleen preservation. Low probability of occurrence of intra-operative and post-operative complications, as well as minimal trauma of tissue, results in a shorter postoperative stay, rapid recovery, and better quality of life.

Laparoscopic Management of Initially Unrecognized Splenic Hydatid Cysts: A Case Report and Review of the Literature

“…Splenic lesions such as simple cysts, pseudocysts, solitary abscesses, and hematomas are the most common differentials [12]. Considering radiologically clearly visible calcifications (Gharbi type III and type IV) and detached germinative membrane (Gharbi type II), we assume that most of the unrecognized splenic hydatid cysts are Gharbi type I as they have a quite similar radiological appearance as simple cysts which are the commonest type of splenic cyst [13].…”

“…Laparoscopic fenestration with excision of the part of the wall represents an effective and definitive treatment for most of the splenic cysts [13]. However, this modality of treatment requires special caution in endemic areas where a higher prevalence of splenic echinococcus can be expected.…”

Splenic cyst following trauma, the intraoperative decision on definitive management

“…Most authors suggests that caution is necessary in applying these procedures due to a high recurrence rate and the possibility that the cyst could be a diagnostically unrecognized parasitic cyst, which is why these methods should be reserved for patients in whom surgical treatment is contraindicated or who refuse surgery [1,5,7].…”

“…The only curative modality of treatment is surgical treatment, which can include less radical procedures through a minimally invasive approach, but also splenectomy [1,5].…”