Surgical Management of Nonparasitic Splenic Cysts

Nonparasitic splenic cysts require a totally different type of surgical management than that of parasitic cysts. Three cases of nonparasitic splenic cysts and their surgical management by the open and laparoscopic approaches are presented. The surgical technique and review of the recent literature are discussed to demonstrate the current trends in the operative management of nonparasitic splenic cysts.     

Posttraumatic Splenic Cysts and Partial Splenectomy: Report of a Case

Nonparasitic splenic cysts are uncommon, with only around 800 cases described in the literature. Posttraumatic splenic pseudocysts constitute most such cases and require surgical treatment when symptomatic or voluminous. Recent studies have provided a better understanding of splenic tissue function and the consequent risks of complete resection of the spleen. Hence surgeons should make every possible effort to preserve splenic tissue. Several spleen-conserving surgical treatments have been proposed, especially for treatment of splenic posttraumatic pseudocysts. The authors report the case of a 13-year-old girl who had a posttraumatic splenic cyst with progressive growth. The diameter of the cyst at surgery was 15 cm, and partial splenectomy was performed. The most common spleen-conserving surgical techniques are briefly reviewed. Received: September 20, 1999 / Accepted: September 26, 2000     

Partial Splenectomy for Benign Splenic Cysts with the Aid of a Lin Clamp: Technical Note

Background Spleen-preserving procedures deserve every effort by surgeons to reduce the risk of overwhelming postsplenectomy infection. Partial splenectomy at hospitals with restricted sources remains technically demanding. We describe our method of partial splenectomy for benign splenic cysts with the aid of a Lin clamp. Patients and Methods Since April 2003 to August 2004, we have performed partial splenectomy with the aid of a Lin clamp on 5 suitable patients with symptomatic cysts. Detailed patient characteristics, operative variables, and outcomes were collected. Following surgery, they were regularly followed up every 6 months. Results All five partial splenectomies were successfully executed without any complications. The mean operating time was 75 minutes, and a mean operative blood loss of 68 ml could be achieved. With a mean follow-up of 34.4 months, no cyst recurrences were detected to date. Postoperative laboratory data, imaging studies, and clinical situations proved that the preserved splenic parenchyma maintained adequate function. Conclusions Partial splenectomy with the aid of a Lin clamp for benign splenic cysts is a practical method with the advantages of easy application, rapid parenchymal dissection, secure hemostasis, and cost-effectiveness. With encouraging preliminary results, further application of this method to bleeding eccentric parenchymal injuries of the spleen may be warranted.     

Partial Splenic Embolization Versus Splenectomy for the Management of Hypersplenism in Cirrhotic Patients

Background  Hypersplenism occurs in patients with chronic liver disease, and splenectomy is the definitive treatment. However, the operation may be hazardous in patients with poor liver function. In recent years, partial splenic embolization (PSE) has been widely used in patients with hypersplenism and cirrhosis. This study was conducted to assess the safety and efficacy of PSE compared to splenectomy in the management of hypersplenism in cirrhotic patients. Methods  This study comprised 40 patients with hypersplenism secondary to cirrhosis. They were divided into two groups, each including 20 patients. The first group of patients were treated by PSE using polyvinyl alcohol particles to achieve embolization of at least 50% of the distal branches of the splenic artery. Postembolization arteriography and computed tomography were performed to document the extent of devascularization. Patients in the second group were treated by splenectomy with or without devascularization and left gastric ligation according to the presence or absence of esophageal varices. Results  There was marked improvement in platelet and leukocytic counts in both groups, and the counts remained at appropriate levels during the follow-up period. All patients in the first group had problems related to postembolization syndrome that abated by the first week. One patient in the first group died from myocardial infarction. No deaths occurred in the second group. Asymptomatic portal vein thrombosis developed in one patient in the first group that was treated with anticoagulation, and another patient developed splenic abscess treated by splenectomy with a good outcome. In the second group, three patients developed portal vein thrombosis, one of them being readmitted 4 months postoperatively with mesenteric vascular occlusion; that patient underwent a resection anastomosis with good outcome. Conclusions  Partial splenic embolization is an effective therapeutic modality for the treatment of hypersplenism secondary to chronic liver disease. It is a simple, rapid procedure that is easily performed under local anesthesia; and it allows preservation of adequate splenic tissue to safeguard against overwhelming infection.     

Laparoscopic Internal Marsupializaton for Large Nonparasitic Splenic Cysts: Effective Organ-Preserving Technique

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.     

Symptomatic Solitary Nonparasitic Liver Cysts

Symptomatic solitary nonparasitic liver cysts are rare, and are treated by aspiration, deroofing or total resection. We present two recent cases of women with very large such cysts, who were successfully treated by conventional deroofing and omentoplasty, since that is in our vision the treatment of choice for this benign pathology.     

Partial Splenectomy is Superior to Total Splenectomy for Selected Patients with Hemangiomas or Cysts

Background

The superiority of partial splenectomy (PS) as a treatment for benign tumors has not well been confirmed. This study aimed to identify the short- and long-term outcomes of PS, to compare laparoscopic and laparotomic PS, and to demonstrate whether the effects of PS are superior to that of total splenectomy (TS).

Methods

Patients with either a hemangioma or cyst who underwent PS or TS from 2009 to 2015 at Qilu Hospital of Shandong University were included. Clinical parameters were collected and analyzed.

Results

A total of 17 patients underwent PS were collected, including 2 men and 15 women with a mean age of 43.9 ± 11.3 years old. Patients who underwent laparoscopic PS (9 cases) had a longer operative time and shorter postoperative hospital stay than those who underwent laparotomy (8 cases). Compared with TS (22 cases), PS significantly decreased the incidence of thrombocytosis, shortened time until drainage removal, and shortened postoperative hospital stay. After an average follow-up of 34.8 months, patients who underwent TS showed a higher incidence of thrombocytosis and splenic vein thrombosis compared with patients underwent PS.

Conclusions

PS is technically feasible and provides favorable short- and long-term outcomes for selected patients with either a hemangioma or cyst compared with TS. Laparoscopic PS shows lower morbidity and equal therapeutic efficacy compared with laparotomic PS and can be widely performed.

     

脾动脉结扎加脾部分切除治疗外伤性脾破裂

目的 总结应用脾动脉结扎加脾部分切除术治疗外伤性脾破裂的临床经验.方法 对本院近8年间收治的64例接受脾动脉结扎加脾部分切除治疗的脾外伤患者的临床资料进行回顾性分析,重点分析脾部分切除术的手术方法、临床疗效和适应证.结果 术中双重结扎脾动脉,然后根据脾脏损伤的情况决定保留脾脏的部位,保证残脾不少于原脾体积的30%.全组无手术死亡病例,术后出现早期并发症者16例(25.0%),其中发热8例,脾窝积液1例,肠梗阻2例,左侧胸腔积液3例,切口感染2例,均经对症处理后治愈.结论 对部分外伤性脾破裂患者的治疗选择脾动脉结扎加脾部分切除术是安全可行的.     

Nonparasitic Cysts of the Liver: Results and Options of Surgical Treatment

n = 9) should be regarded as a palliative measure. Within a short period, CT-guided aspiration led to recurrence of symptoms in seven of our patients. Standard treatment of NPHC is fenestration with widest possible excision of the cystic wall, which can be performed laparoscopically ( n = 10) or by the conventional surgical mode ( n = 54). One patient was initially operated by the laparoscopic technique but developed bleeding, which necessitated conversion to the open mode. Three patients underwent synchronous laparoscopic cholecystectomy. Recurrence rates were similar: 11% in the laparoscopically treated group and 13% in the group that underwent conventional open surgery. Conventional surgical treatment was always successful in cases of solitary cysts. However, in cases of multiple cysts measuring more than 5 cm, conventional surgery was followed by recurrence of symptoms in 26% of patients (7/27), who then had to undergo a second operation. Partial resection of the liver ( n = 9) was successfully performed in cases of polycystic disease ( n = 5) with concomitant enlargement of the organ as well as in cases of large solitary cysts of the left lobe of the liver ( n = 4). In patients in whom we found that the cysts communicated with the ductal system ( n = 3), we performed a cystojejunostomy to drain the bile. The complication rate was low. In addition to frequent postoperative ascites, which necessitated no further intervention, we observed infectious complications in four patients. Twenty patients (22%) expired during a mean follow-up period of 6.2 years. Interestingly, deaths were frequently associated with malignancy (11/20). After fenestration of multiple cysts measuring > 5 cm, the patients are at high risk for recurrence. Hence partial resection of the liver is an excellent therapeutic alternative in selected patients with polycystic disease and massive enlargement of the organ in whom the disease could not be controlled by simple fenestration. The results of this study show that laparoscopic fenestration should replace the conventional surgical technique as the gold standard in cases of NPHC because the laparoscopic technique is less stressful for the patient and is associated with a rate of success similar to that of the conventional technique.     

Laparoscopic Splenectomy for Isolated Splenic Sarcoidosis

Introduction:

Sarcoidosis is an inflammatory disease with an unknown etiology. The pulmonary interstitium is mainly involved, with noncaseating granulomas and lymphadenopathy. It is a multisystemic disease, and the differential diagnosis should include infectious, neoplastic, and autoimmune diseases to prevent inappropriate treatment and unnecessary surgery. Abdominal disease without evidence of pulmonary abnormalities on chest radiography in sarcoidosis can be found in approximately 25% to 38% of cases.The approach to isolated splenic nodules in a patient with nonspecific abdominal symptoms should be focused on exclusion of malignancies and infections, and may require computed tomography, magnetic resonance imaging, and positron emission tomography–computed tomography imaging; scintigraphy; bone marrow biopsy; breast and genital examinations; and endoscopies.This report documents a rare case of isolated granulomatous disease of the spleen that was diagnosed and treated laparoscopically.

Case:

A 29-year-old woman presented with nonspecific complaints such as nausea, vomiting, and epigastric discomfort. Further laboratory test results were normal. Abdominal ultrasonography, computed tomography, and magnetic resonance imaging revealed multiple splenic lesions. Additional examination findings were negative for occult neoplasia or infectious disease. Laparoscopic splenectomy was performed as a diagnostic procedure, without complications, and the final diagnosis was sarcoidosis.

Conclusion:

Isolated splenic sarcoidosis is a rare manifestation of extrapulmonary disease. The final diagnosis may be achieved only by histology, requiring biopsy or splenectomy. Minimally invasive surgery is a safe and efficient method for diseases of the spleen and should be the first option when feasible. The patient did well; however, further monitoring is required to diagnose recurrence.     

腹腔镜下脾囊肿的保脾术探讨

目的探讨腹腔镜下脾囊肿保脾手术的可行性。方法应用腹腔镜微创器械和镜下单人双手操作缝合技术为8例脾囊肿施行保脾手术,根据囊肿所处的部位、大小、性质,采用囊肿完整剥除4例,脾部分切除2例,囊肿去顶开窗引流2例。结果8例脾囊肿都成功地完成了腹腔镜下去除囊肿和脾脏的保留,手术时间60～120min,平均100min;术中出血量60～120ml,平均80ml。术后无出血、感染等并发症,4～6d出院。8例术后随访1～72个月,平均38个月,恢复良好,无复发。结论腹腔镜下去除囊肿而保存脾脏的术式可行。     

Splenic Hydatid Cysts: 17 Cases

Hydatid cyst disease, which is endemically observed and an important health problem in our country, involves the spleen at a frequency ranking third following the liver and the lungs. In this study, we aimed to evaluate the efficacy and results of management in splenic hydatid cysts. The demographic data, localization, diagnosis, treatment methods, and the length of postoperative hospital stay of patients with splenic hydatid cysts in a 12-year period were evaluated retrospectively. Seventeen cases were evaluated. Among these, 13 were females and four were males. Seven had solitary splenic involvement, eight had involvement of both the spleen and the liver, and two had multiple organ involvement. Ten had undergone splenectomy, one had undergone distal splenectomy, and the remaining cases had undergone different surgical procedures. The patients had received albendazole treatment in the pre- and postoperative period. One patient had died secondary to hypernatremia on the first postoperative day. The clinical picture in splenic hydatid cysts, which is seen rarely, is usually asymptomatic. The diagnosis is established by ultrasonography and abdominal CT. Although splenectomy is the standard mode of treatment, spleen-preserving methods may be used.     

急诊腹腔镜脾切除术在外伤性脾破裂中的应用

目的探讨急诊腹腔镜脾切除术（1aparoscopic splenectomy,LS）治疗外伤性脾破裂的可行性。方法回顾分析我院2010年11月-2012年3月因外伤性脾破裂行急诊Ls20例的临床资料,根据脾蒂的不同类型,18例用Endo．GIA施行一级脾蒂离断,2例用Hem-o-lok施行二级脾蒂离断。结果20例手术均成功,无中转开腹,手术时间80-180min,平均110min,术中腹腔内有出血约700-1,2500ml,平均1300ml。术后无明显并发症发生。20例术后随访6个月,所有患者10天基本恢复正常生活,15—45天恢复正常工作,无严重术后并发症。结论急诊Ls治疗外伤性脾破裂可行。     

Splenic Autotransplantation Is Always Valid after Splenectomy

When splenectomy is performed, autotransplantation is the only method to preserve splenic function. The most frequently used technique for splenic autotransplantation in humans is the implantation of multiple sections of the splenic parenchyma into pouches created in the greater omentum. However, this technique of autotransplantation is associated with complications. For this reason, a technique in which only one 35-g slice of spleen is transplanted into the greater omentum but positioned within the native hypochondrium can be considered safe and useful for patients. Experimental studies continue to add valuable information to the ongoing research in the field of autotransplantation, providing a baseline for future studies in humans and adding arguments in favor of autotransplantation when the spleen cannot be preserved.     

Laparoscopic Treatment of Nonparasitic Liver Cysts: Adequate Selection of Patients and Surgical Technique

Results of laparoscopic fenestration in patients with a highly symptomatic solitary liver cyst (17 patients) or polycystic liver disease (PLD) (9 patients) were prospectively evaluated in a multicenter practice of general surgeons. Conversion to laparotomy was required in two patients because of inaccessible deep liver cyst in one and a diffuse form of PLD in the other. There was no mortality or major morbidity. Mean postoperative hospital stay was 4.6 days after successful laparoscopic procedures. During a mean follow-up of 9 months, 23% of the patients had recurrence of symptoms and 38% had radiographic reappearance of cysts. Factors predicting failure included previous surgical treatment, deep-sited cysts, incomplete deroofing technique, location in the right posterior segments of the liver, and a diffuse form of PLD with small cysts. Adequate selection of patients and type of cystic liver disease and meticulous and aggressive surgical technique are recommended.