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Anand U, Bhadani PP, Kumar R, Priyadarshi RN, John AG. A giant epidermoid cyst of spleen: A differential diagnosis for cystic neoplasm of pancreas. Med J Armed Forces India 2023; 79:S379-S381. [PMID: 38144626 PMCID: PMC10746742 DOI: 10.1016/j.mjafi.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Utpal Anand
- Associate Professor (Surgical Gastroenterology), AIIMS, Patna, India
| | | | - Ramesh Kumar
- Associate Professor (Gastroenterology), AIIMS, Patna, India
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Khanna S, Barua A, Haloi D. Robotic-assisted excision of splenic epidermoid cyst in an adolescent patient in a new robotic platform: A case report. J Minim Access Surg 2023; 19:323-325. [PMID: 36629223 PMCID: PMC10246637 DOI: 10.4103/jmas.jmas_213_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022] Open
Abstract
Laparoscopic management of non-parasitic cysts (NSCs) of the spleen is currently the standard of care. There is a paucity of data of robotic management of NSCs. Here, we report a case of a NSC in a 13-year-old male. The patient presented to us with the chief complaints of pain in abdomen and feeling of a left upper abdomen lump for the last 3 months. The spleen being an important organ for immunity, we decided to opt for splenic preservation. Since minimal access methods offer the best outcome and we wanted to go with a safe option, we settled for near-total cystectomy of the splenic cyst. Here, we review the literature regarding the surgical management of NSCs and discuss the robotic technique for the accomplishment of the surgery.
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Affiliation(s)
- Subhash Khanna
- Department of GI, Minimal Access and Robotic Surgery, Swagat Superspeciality Surgical Hospital, Guwahati, Assam, India
| | - Areendam Barua
- Department of GI, Minimal Access and Robotic Surgery, Swagat Superspeciality Surgical Hospital, Guwahati, Assam, India
| | - Dhanjit Haloi
- Alliance Healthcare and Research Centre, Guwahati, Assam, India
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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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Dapri G, Arts S. Technique for Reduced Trocar Decapsulation of a Giant Nonparasitic Splenic Cyst. Surg Laparosc Endosc Percutan Tech 2021; 31:804-807. [PMID: 34075010 DOI: 10.1097/sle.0000000000000958] [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: 03/14/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minimally invasive surgery is adopted for patients presenting benign splenic cysts. Reduced port laparoscopy is an evolution of conventional laparoscopy, which can be applied for splenic cysts as well. In this video, a 3-trocar laparoscopic decapsulation of a giant nonparasitic splenic cyst is reported. CASE REPORT A 16-year-old man, without history of trauma or abdominal surgery, suddenly presented abdominal pain in the left hypochondrium, associated to fever and hyperleukocytosis. A thoracoabdominal computed tomography scan showed a giant cyst of the upper pole of the spleen; serum tumor markers carcinoembryonic antigen and carbohydrate antigen 19-9 were negatives. Any preoperative vaccine was prescribed. RESULTS Operative time was 130 minutes, and operative bleeding 10 mL. No additional trocar or conversion to laparotomy was necessary. Postoperatively, 4 g of paracetamol were used for 2 days, when the patient was discharged. Pathology confirmed the nonparasitic epidermoid splenic cyst. At 18 months, the patient is fine, without symptoms and without disease's recurrence. CONCLUSIONS Decapsulation of a giant nonparasitic splenic cyst is feasible to be performed by 3-trocar laparoscopy. This technique allows to improve the patient's comfort and the cosmetic results, to reduce the postoperative pain and to finally avoid a preoperative vaccine.
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Affiliation(s)
- Giovanni Dapri
- International School Reduced Scar Laparoscopy, Brussels, Belgium
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Chung P, Swinson B, O'Rourke N, Schmidt B. Massive splenic cyst in pregnancy: case report. BMC Pregnancy Childbirth 2020; 20:273. [PMID: 32375702 PMCID: PMC7201964 DOI: 10.1186/s12884-020-02968-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary splenic cysts are very rarely diagnosed in pregnancy, with only thirteen cases described in the literature. We examine the approach towards diagnosing and managing uniquely large abdominal masses that significantly complicate obstetric care. CASE PRESENTATION A 37-year-old primigravida woman presented with abdominal distension and discomfort, yet otherwise asymptomatic. On ultrasound, an incidental pregnancy at 25 weeks of gestation and a large pelvic lesion were discovered. MRI defined a 28 × 29 cm lobulated, complex cystic mass in the upper abdomen. The patient underwent two ascitic drainages throughout her pregnancy. At 34 weeks of gestation, she had a classical caesarean section. Then at five-weeks postpartum, she underwent a laparotomy and total splenectomy with 16 L of fluid drained. Histopathological analysis revealed an epithelial cyst of the spleen. Her recovery was complicated by complete portal vein thrombosis. CONCLUSION This case describes the largest splenic cyst ever reported in pregnancy and explores the diagnostic dilemmas and treatment challenges associated. We introduce the utility of serial ascitic drainages in prolonging the pregnancy and emphasise the reliance on imaging for surveillance of splenic size and fetal wellbeing.
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Affiliation(s)
- Philip Chung
- Department of Obstetrics and Gynaecology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.
| | - Ben Swinson
- Department of General Surgery, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Nicholas O'Rourke
- Department of General Surgery, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Bart Schmidt
- Department of Obstetrics and Gynaecology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
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Abstract
BACKGROUND Laparoscopic partial splenectomy (LPS) is a challenging procedure. The aim of this review was to evaluate its feasibility, safety, and potential benefits. METHODS We conducted a comprehensive review for the years 1995-2018 to retrieve all relevant articles. RESULTS A total of 44 studies with 252 patients undergoing LPS were reviewed. Six studies described combined operations. Ranges of operative time and estimated blood loss were 50-225 min and 0-1200 ml, respectively. There are eight patients need blood transfusion in 231 patients with available data. The conversion rate was 3.6% (9/252). Overall, 27 patients (10.7%;27/252) developed postoperative or intraoperative complications. Overall mortality was 0% (0/252). The length of postoperative stay (POS) varied (1-11 days). Among four comparative studies, one showed LPS could reduce POS than laparoscopic total splenectomy (LTS) (LTS 5.4 ± 1.8 days, LPS 4.2 ± 0.8 days, p = 0.027) and complications (pleural effusion (LTS 9/22, LPS 0/15, p = 0.005), splenic vein thrombosis (LTS 10/22, LPS 0/15, p = 0.002)). Another comparative study showed LPS may benefit emergency patients. However, one comparative study showed LPS was associated with more pain, longer time to oral intake, and longer POS in children with hereditary spherocytosis. The fourth comparative study showed robotic subtotal splenectomy was comparable to laparoscopy in terms of POS and complication. The main benefits were lower blood loss, vascular dissection time, and a better evaluation of splenic remnant volume. CONCLUSIONS In early series of highly selected patients, LPS appears to be feasible and safe when performed by experienced laparoscopic surgeons.
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Affiliation(s)
- Gangshan Liu
- Department of the Second General Surgery, Sheng Jing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang City, Liaoning Province, China
| | - Ying Fan
- Department of the Second General Surgery, Sheng Jing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang City, Liaoning Province, China.
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Okuno M, Yuasa N, Takeuchi E, Goto Y, Miyake H, Nagai H, Yoshioka Y, Miyata K. A case of ruptured splenic cyst with elevated serum levels of CEA treated by laparoscopic unroofing. Clin J Gastroenterol 2019; 12:642-649. [PMID: 30972710 DOI: 10.1007/s12328-019-00980-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/04/2019] [Indexed: 11/26/2022]
Abstract
Splenic cysts are rare and tend to have elevated tumor markers, of which carbohydrate antigen (CA) 19-9 is the most frequently elevated. Therefore, splenic cysts with elevated serum carcinoembryonic antigen (CEA) levels and without CA19-9 elevation are extremely rare. A 26-year-old woman presented with sudden upper abdominal pain while sleeping. Contrast-enhanced computed tomography (CT) showed an 85-mm simple splenic cyst in the upper pole and a moderate amount of ascites around the spleen. The serum levels of CEA, but not CA19-9, were elevated. Spontaneous rupture of a splenic cyst was diagnosed. We performed elective laparoscopic unroofing. The histological findings revealed a stratified squamous epithelium on the inner surface of the cystic wall. On immunohistochemical examination, the squamous epithelium was found to be positive for cytokeratin (CK)7, negative for calretinin, and positive for CEA. The histological diagnosis was an epidermoid cyst. Three months after the operation, the elevated serum tumor marker levels of CEA were normalized. Splenic cysts with high levels of CEA and low levels of CA19-9 are extremely rare. Laparoscopic unroofing is a useful operative procedure for ruptured splenic cysts with elevated levels of serum tumor markers.
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Affiliation(s)
- Masataka Okuno
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
| | - Norihiro Yuasa
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Eiji Takeuchi
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Yasutomo Goto
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hideo Miyake
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hidemasa Nagai
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Yuichiro Yoshioka
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Kanji Miyata
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
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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: 0.7] [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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A Sleiman Y, Bohlok A, El-Khoury M, Demetter P, Zalcman M, El Nakadi I. Splenic epithelial cyst mistaken with Hydatid cyst: A case report. Int J Surg Case Rep 2018; 53:21-24. [PMID: 30366172 PMCID: PMC6203242 DOI: 10.1016/j.ijscr.2018.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/25/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Cystic lesions of the spleen are infrequent and usually diagnosed incidentally. These lesions are rare and their differential diagnosis is very wide. Splenic epithelial cysts are the most common type of primary splenic cyst (4%). Surgical treatment is indicated for cysts larger than 5 cm or symptomatic. Nowadays, spleen preserving surgery is the gold standard treatment considering the immunologic role of the spleen and the increased risk of post-splenectomy infections. CASE PRESENTATION A 17 year old girl presented to the outpatient clinic with moderate left upper quadrant abdominal pain of 2 weeks duration with loss of appetite and denied fever, chills, sweating and jaundice. Abdominal examination showed tender splenomegaly. The abdominal imaging (Ultrasound, CT SCAN, MRI) was suggestive of hydatid cyst of the spleen, for which she received Albendazole for 1 month and then operated by laparotomy with partial resection and un-roofing of the splenic cyst. The pathology report showed a splenic epithelial cyst (SEC). CONCLUSION SEC is a rare pathology that could mimic splenic hydatid cyst. The clinical and radiological pictures may be commonly misleading and non-conclusive. Definitive diagnosis is made on histopathology. Spleen conserving surgery, when possible, is the preferred modality for treatment.
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Affiliation(s)
- Youssef A Sleiman
- Service de Chirurgie, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Belgium
| | - Ali Bohlok
- Service de Chirurgie, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Belgium
| | | | - Pieter Demetter
- Service d'Anatomie Pathologique, Erasme, Université Libre de Bruxelles (ULB), Belgium
| | - Marc Zalcman
- Service de radiologie, Erasme, Université Libre de Bruxelles (ULB), Belgium
| | - Issam El Nakadi
- Service de Chirurgie, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Belgium.
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Temiz A. Comment on "Management of nonparasitic splenic cysts in children: A French multicenter review of 100 cases". J Pediatr Surg 2018; 53:1632. [PMID: 29678406 DOI: 10.1016/j.jpedsurg.2018.02.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Abdulkerim Temiz
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Ankara, Turkey.
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Elhardello O, Ammori BJ. Splenic pedicle control during laparoscopic de-capsulation of a giant splenic cyst. J Surg Case Rep 2018; 2018:rjx255. [PMID: 29321842 PMCID: PMC5755232 DOI: 10.1093/jscr/rjx255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/27/2017] [Accepted: 12/24/2017] [Indexed: 01/10/2023] Open
Abstract
Splenic cysts are a rare entity in the Western population and are either true cysts (primary, 25%) or pseudocysts (secondary, 75%) complicating trauma, haemorrhage or infarction. Congenital or simple splenic cysts are the commonest primary cysts and surgery is recommended for cysts larger than 5 cm as these are prone to infection, bleeding or rupture and for symptomatic or complicated cysts. Splenic preservation techniques using the laparoscopic approach are the most prevalent. We present a case of a giant painful simple splenic cyst treated with laparoscopic de-capsulation with application of a new technique for achieving vascular control, whereby control of the splenic pedicle was achieved using a Nylon tape. This approach was safe and well tolerated with a total splenic ischaemia time of 30 min and a successful result. The patient was discharged with no antecedent complications and no recurrence of the cyst at 6 months follow up ultrasound scan.
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Affiliation(s)
- Osama Elhardello
- Department of General Surgery, Scarborough General Hospital, Scarborough YO12 6QL, UK
| | - Basil J Ammori
- Department of General Surgery, Scarborough General Hospital, Scarborough YO12 6QL, UK.,Institute of inflammation and repair, University of Manchester, Manchester M13 9P, UK
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Misiakos EP, Bagias G, Liakakos T, Machairas A. Laparoscopic splenectomy: Current concepts. World J Gastrointest Endosc 2017; 9:428-437. [PMID: 28979707 PMCID: PMC5605342 DOI: 10.4253/wjge.v9.i9.428] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/21/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
Since early 1990’s, when it was inaugurally introduced, laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. However some contraindications still apply. The evolution of the technology has allowed though, cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased experience of surgeons allows operative times comparable to those of an open splenectomy. In this review we discuss the indications and the contraindications of laparoscopic splenectomy. Moreover we analyze the standard and modified surgical approaches, and we evaluate the short-term and long-term outcomes.
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Affiliation(s)
- Evangelos P Misiakos
- 3rd Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Attica, 12462 Athens, Greece
| | - George Bagias
- Clinic for General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Theodore Liakakos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, 11527 Athens, Greece
| | - Anastasios Machairas
- 3rd Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Attica, 12462 Athens, Greece
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Valverde Martinez A, Roldan Ortiz S, Fornell Ariza M, Castro Santiago MJ. Partial splenectomy for a giant epidermoid cyst of the spleen. Clin Case Rep 2016; 4:1013-1016. [PMID: 27761259 PMCID: PMC5054483 DOI: 10.1002/ccr3.670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/31/2016] [Accepted: 08/03/2016] [Indexed: 11/20/2022] Open
Abstract
The splenic epidermoid cysts are rare benign tumors, and a definitive treatment remains unclear. Although some spleen‐preserving approaches have been reportedly used, splenic cyst recurrence usually occurs in true cyst cases, wherein the cyst is incompletely removed. In our case, partial splenectomy was performed and the giant cyst was completely removed.
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Affiliation(s)
- Amparo Valverde Martinez
- General Surgery University Hospital Puerta del Mar from Cádiz Avda. Ana de Viya s/n Cádiz 11009 Spain
| | - Susana Roldan Ortiz
- General Surgery University Hospital Puerta del Mar from Cádiz Avda. Ana de Viya s/n Cádiz 11009 Spain
| | - Mercedes Fornell Ariza
- General Surgery University Hospital Puerta del Mar from Cádiz Avda. Ana de Viya s/n Cádiz 11009 Spain
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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: 1.0] [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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Matsui T, Matsubayashi H, Sugiura T, Sasaki K, Ito H, Hotta K, Imai K, Tanaka M, Kakushima N, Ono H. A Splenic Epithelial Cyst: Increased Size, Exacerbation of Symptoms, and Elevated Levels of Serum Carcinogenic Antigen 19-9 after 6-year Follow-up. Intern Med 2016; 55:2629-34. [PMID: 27629958 DOI: 10.2169/internalmedicine.55.6970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old man, who had presented with a large cyst between the pancreatic tail and splenic hilum 6 years previously, was referred to our hospital with exacerbation of abdominal distention. Computed tomography revealed a well-demarcated, unilocular cyst, with a beak sign for the pancreas, without wall thickening or nodules suggestive of a non-neoplastic cyst. Compared with 6 years previously, the cyst had increased in size from 14.7 cm to 19.5 cm, and the serum carcinogenic antigen 19-9 level had increased from 635 U/mL to 1,918 U/mL. To prevent spontaneous rupture, laparotomy was performed, and the cyst was pathologically diagnosed as a splenic epithelial cyst.
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Affiliation(s)
- Toru Matsui
- Division of Endoscopy, Shizuoka Cancer Center, Japan
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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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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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Iimuro Y, Okada T, Sueoka H, Hai S, Kondo Y, Suzumura K, Fujimoto J. Laparoscopic management of giant splenic true cyst with partial splenectomy: a case report. Asian J Endosc Surg 2013; 6:226-30. [PMID: 23879417 DOI: 10.1111/ases.12024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/10/2013] [Accepted: 01/20/2013] [Indexed: 12/19/2022]
Abstract
Non-parasitic splenic cysts are relatively rare, and the optimal surgical treatment for them remains controversial. Laparoscopic unroofing is a relatively safe and easy technique, but a significant number of recurrences has been reported. Thus, complete cystectomy with partial splenectomy is recommended by several surgeons. However, patients sometimes suffer from intraoperative bleeding. Here, we report a patient with a giant non-parasitic splenic cyst who underwent subtotal cystectomy with partial splenectomy. After the dissection of the vessels circulating the upper pole at the splenic hilum, the resection line of the splenic parenchyma was on the ischemic side of the cyanotic demarcation line. A vessel sealing system and laparoscopic coagulation shears were used for the resection. We intentionally left about 10% of the cyst wall to avoid bleeding from the non-ischemic splenic parenchyma and remaining vessels. No recurrence has been detected after 6 months of observation. We believe this method could be a useful alternative procedure for the treatment of non-parasitic splenic cysts and preservation of the splenic parenchyma.
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Affiliation(s)
- Yuji Iimuro
- Department of Surgery, Hyogo College of Medicine, Nishnomiya, Japan.
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Altıntoprak F, Dikicier E, Kıvılcım T, Ergönenç T, Dilek ON. Pseudocyst of Spleen;
An Uncommon Clinical Entity, although Common Theoretically. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2012; 9:43-46. [DOI: 10.29333/ejgm/82540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Total Splenectomy due to an Unexpected "Complication" after Successful Extended Laparoscopic Partial Decapsulation of a Giant Epidermoid Splenic Cyst: A Case Report. Case Rep Med 2011; 2011:318208. [PMID: 21687593 PMCID: PMC3114453 DOI: 10.1155/2011/318208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 04/13/2011] [Indexed: 11/23/2022] Open
Abstract
Splenic cysts are rare entities and are classified as true cysts or pseudocysts based on the presence of an epithelial lining. Congenital nonparasitic true cysts can be epidermoid, dermoid, or endodermoid, present at a young age, and are commonly located in the upper pole of the spleen. Surgical treatment is recommended for symptomatic, large (more than 5 cm), or complicated cysts. Depending on cyst number, location, relation to hilus, and the major splenic vessels, the surgical options include aspiration, marsupialization, cystectomy, partial cystectomy (decapsulation), and partial or complete splenectomy. Laparoscopic techniques have now become the standard approach for many conditions, including the splenic cysts, with emphasis on the spleen-preserving minimally invasive operations. We present the successful extended partial laparoscopic decapsulation of a giant epidermoid splenic cyst in a young female patient that, although asymptomatic, was unfortunately followed by complete splenectomy five days later due to a misinterpreted abdominal CT suggesting splenic postoperative ischemia.
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Papadopoulos IN, Davatzikos A, Kasabalis G, Manti C, Konstantoudakis G. Primary epithelial splenic cyst with micro-rupture and raised carbohydrate antigen CA 19-9: a paradigm of management. BMJ Case Rep 2010; 2010:2010/oct29_1/bcr0620103125. [PMID: 22791783 DOI: 10.1136/bcr.06.2010.3125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Epithelial splenic cysts are rare entities which surgeons may not have previously encountered. Their management is based on historical studies. A 21-year-old woman presented with a cyst of the spleen that produced a high serum concentration of carbohydrate antigen CA 19-9. A partial splenectomy with removal of the entire cyst and preservation of the splenic parenchyma by laparotomy was performed and the patient made an uneventful recovery. A microscopic rupture of the wall of the cyst and blood degradation products in the fluid of the cyst were confirmed. A functional splenic parenchyma was documented 18 months after surgery. There was no infection during follow-up. Partial surgical splenectomy with resection of the entire cyst prevents recurrence and preserves splenic function.
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Affiliation(s)
- Iordanis N Papadopoulos
- Fourth Surgery Department, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece.
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Papadopoulos IN, Davatzikos A, Kasabalis G, Manti C, Konstantoudakis G. Primary epithelial splenic cyst with micro-rupture and raised carbohydrate antigen CA 19-9: a paradigm of management. BMJ Case Rep 2010; 2010:2010/aug24_1/bcr0120102636. [PMID: 22767471 DOI: 10.1136/bcr.01.2010.2636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Epithelial splenic cysts are rare entities that surgeons might not have previously encountered and their management is based on historical studies. A 21-year-old female presented with a cyst of the spleen that produced a high serum concentration of carbohydrate antigen CA 19-9. A partial splenectomy with the removal of the entire cyst and preservation of splenic parenchyma by laparotomy was performed and the patient made an uneventful recovery. A microscopic rupture of the wall of the cyst and degradation of blood in the fluid of the cyst were confirmed. Eighteen months following surgery a functional splenic parenchyma was documented. There was no episode of infection during this follow-up time. Partial surgical splenectomy with resection of the entire cyst prevents recurrence and preserves splenic function.
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Affiliation(s)
- Iordanis N Papadopoulos
- Fourth Surgery Department, National & Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece.
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Abstract
Laparoscopic splenectomy (LS) has become the standard approach to splenectomy for benign and malignant hematologic diseases despite a paucity of high-level evidence. The procedure requires expertise in laparoscopic surgical techniques and meticulous dissection of the spleen. Management should include a preoperative radiologic assessment to measure splenic volume and to detect the presence of accessory splenic tissue; the patient should undergo preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections. Prophylactic antibiotics are used in the perioperative period as well as prophylactic anticoagulation therapy which may be continued long-term in high-risk patients. LS is associated with a low morbidity and mortality; when compared to laparotomy, it reduces the length of hospital stay and improves the quality of life by decreasing postoperative ileus and pain. There are a variety of laparoscopic approaches; the hand-assisted technique and newer coagulating devices have facilitated the operative technique leading to increasing acceptance of laparoscopy as the preferred approach - even in patients with malignant hematologic disease and/or massive splenomegaly.
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Affiliation(s)
- F Borie
- Service de chirurgie digestive B, CHU Carémeau, place de Pr-Debré, 30029 Nimes, France.
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Mattioli G, Avanzini S, Pini Prato A, Asquasciati C, Rapuzzi G, Costanzo S, Basile A, Rossi V, Bisio G, Boeri E, Montobbio G, Jasonni V. Spleen surgery in pediatric age: seven-year unicentric experience. J Laparoendosc Adv Surg Tech A 2009; 19:437-41. [PMID: 19245317 DOI: 10.1089/lap.2008.0289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Either "open" and laparoscopic spleen surgery in pediatric age are well known and performed with ease in children. Yet, few data regarding follow-up and outcome are discussed in the international literature. MATERIALS AND METHODS Clinical notes of all patient who underwent spleen surgery in a single center between 2000 and 2007 were reviewed and a specific follow-up questionnaire was administered, aiming to evaluate pre- and postoperative data, especially considering underlying disease, cosmetic results, and quality of life after surgery. RESULTS Fifty-one patients underwent spleen surgery in our series, 33 of whom returned a complete follow-up questionnaire and were included in the study. Splenectomy was performed in 26 patients, whereas 7 patients underwent a partial splenectomy; 19 cases (57.6%) were approached laparoscopically. A total of 4 complications (12%) occurred in our series, none of them being intraoperative. Hospital stay resulted as significantly shorter in laparoscopic cases (5.5 +/- 2.9 vs. 8.7 +/- 4.8 days; P < 0.01), with better results in terms of cosmetics. Quality of life is strictly related to underlying disease, as well as long-term survival. CONCLUSIONS Whatever surgical approach is adopted, spleen surgery is safe, effective, and reproducible. When feasible, the laparoscopic approach should be preferred to the traditional open approach, as far as efficacy and safety are similar, in order to reduce hospital stay, abdominal wall traumatism, and consequently, improve postoperative pain control and cosmetic results.
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Affiliation(s)
- Girolamo Mattioli
- Department of Pediatric Surgery, G. Gaslini Children's University Institute, Genoa, Italy., University of Genoa, Genoa, Italy.
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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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Splenic cysts, many questions are yet to be answered: a case report. CASES JOURNAL 2009; 2:8474. [PMID: 19830078 PMCID: PMC2740232 DOI: 10.4076/1757-1626-2-8474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 06/19/2009] [Indexed: 11/28/2022]
Abstract
We present two patients with splenic cysts. The first is a female 29-years-old who presented with upper abdominal discomfort of one-year duration. Imaging revealed a huge splenic cyst. Splenectomy was undertaken. Pathological examination revealed a lymphatic cyst. The second was an 18-years-old female who presented to the emergency department with a ruptured splenic cyst. Splenectomy was undertaken, it proved to be a simple cyst.
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Uludag M, Yetkin G, Citgez B, Karakoc S, Polat N, Yener S. Giant true cyst of the spleen with elevated serum markers, carbohydrate antigen 19-9 and cancer antigen 125. BMJ Case Rep 2009; 2009:bcr03.2009.1691. [PMID: 21686973 DOI: 10.1136/bcr.03.2009.1691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 19-year-old woman presented with a left upper abdominal mass. Computed tomography of the abdomen showed a solitary cystic lesion in the splenic hilum, approximately 20×16 cm in size, demonstrating almost total displacement of the remaining splenic parenchyma. She had high serum concentrations of carbohydrate antigen 19-9 and cancer antigen 125. A splenectomy was performed. Immunohistochemical study confirmed the existence of an epithelial cyst. Following surgery, the serum concentrations of the tumour markers decreased gradually. True splenic cysts are rare and their origin is controversial. In splenic cysts with high serum concentrations of tumour markers, such as occurred in our patient, cystectomy or splenectomy were preferred to remove tumour marker-producing epithelium and to prevent recurrence after treatment. If the epithelial lining of the cyst cannot be detected under light microscopy, immunohistochemical study should be performed.
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Affiliation(s)
- Mehmet Uludag
- Sisli Etfal Training and Research Hospital, 2nd General Surgery, Etfal sokak No: 1, Istanbul, 34360, Turkey
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Laparoscopic partial splenic resection in hydatid disease. Eur Surg 2009. [DOI: 10.1007/s10353-009-0458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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: 1.4] [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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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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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: 9.8] [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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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: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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