Laparoscopic fenestration and modified marsupialization of posttraumatic splenic cysts using a harmonic scalpel

   apd: 14 May 2001     

Laparoscopic splenectomy for recurrent splenic cyst after laparoscopic marsupialization

We describe laparoscopic splenectomy for recurrent splenic cyst after laparoscopic marsupialization. The patient was a 24-year-old woman with a 20-cm palpable mass in the left upper quadrant. She had undergone laparoscopic marsupialization for splenic cyst 62 months previously. Abdominal ultrasonography and computed tomography revealed a huge cystic lesion of the spleen, and magnetic resonance imaging demonstrated multiple cystic lesions occupying almost the entire spleen. We performed laparoscopic splenectomy for the recurrent splenic cyst. The operation took 170 minutes. Histologic examination of the resected spleen revealed a hemangioma with cyst formation. The cyst wall consisted of fibrous tissue, covered by stratified cuboid or squamous epithelium. The patient had no abdominal symptoms during 13 months of follow-up. Postoperative follow-up examination by ultrasound or computed tomography is required after surgical treatment for splenic cyst to exclude the possibility of recurrence after preservation of the spleen.     

Laparoscopic management of splenic cysts: marsupialization, cavity lining with surgicel and omentopexy to prevent recurrence

INTRODUCTION: Open total splenectomy, once the treatment of choice for splenic cysts, has largely been replaced by laparoscopic, splenic preserving procedures. These techniques have resulted in reduced hospitalization times and rates of overwhelming postsplenectomy infection. We report 2 cases of laparoscopic management of large, symptomatic splenic cysts. METHODS: Two patients presented with symptomatic splenic cysts. The first was a simple cyst by history, the second a posttraumatic cyst. Both patients were treated by laparoscopic cyst marsupialization followed by lining the cavity with Surgicel (Ethicon, Somerville, NJ) and performance of an omentopexy. RESULTS: Both procedures were performed without complication. At 25 months, neither patient showed any evidence of symptomatic or radiologic recurrence. Pathology confirmed the preoperative diagnoses. CONCLUSIONS: Laparoscopic marsupialization of splenic cysts in combination with lining the cyst cavity with Surgicel and omentopexy is a safe, feasible, and efficacious method of management with excellent results at 25-month follow-up.     

Laparoscopic marsupialization of a giant posttraumatic splenic cyst.

BACKGROUND AND OBJECTIVE: Nonparasitic cysts are rare clinical lesions of the spleen. Causes include congenital malformations and trauma. Historically, management has entailed partial or total splenectomy using an open approach. Recently, laparoscopic approaches have been developed. In this report, we describe laparoscopic marsupialization of a giant splenic cyst (diameter > 15 cm). METHODS: A 25-year-old African-American man presented with a 9-month history of early satiety, constipation, and left upper quadrant pain. Additionally, he reported blunt trauma to the abdomen 2 years earlier. Physical examination revealed a large, fixed, nontender left upper quadrant mass. Computed tomography scan confirmed a simple cyst within the spleen, measuring 20 x 25 cm. Echinococcus and Entamoeba histolytica serologies were negative. Laparoscopic exploration was performed. Four liters of brown fluid were aspirated and intraoperative cytology confirmed a nonparasitic cyst. The cyst wall was excised and the cavity was packed with omentum. RESULTS: The patient's recovery was uneventful, and he was discharged to home tolerating a regular diet on postoperative day 3. At 6-month follow-up, the patient was asymptomatic and showed no evidence of recurrence. CONCLUSION: Nonparasitic splenic cysts are rare lesions. Laparoscopic marsupialization is safe and effective for giant nonparasitic splenic cysts and should be considered the treatment of choice.     

Laparoscopic treatment of splenic cysts.

Presented here is a case report of laparoscopic fenestration of a symptomatic, nonparasitic splenic cyst. Technical aspects of the procedure are discussed along with a review of the literature. The laparoscopic approach to splenic cysts offers many advantages over traditional open procedures and may be the treatment of choice for this rare clinical problem.     

Laparoscopic management of non-parasitic splenic cysts

Non-parasitic cysts are an infrequent disease of the spleen. Most likely congenital in their origin, epithelial splenic cysts require surgical treatment if enlarged or symptomatic. The aim of this study was to assess the impact of the laparoscopic technique in the management of splenomegaly due to cystic disease. From July 2001 to September 2002 4 patients underwent laparoscopic splenectomy in our department for symptomatic enlarged non-parasitic splenic cysts. Cystic lesions were evaluated by ultrasonography, CT scan and magnetic resonance of the abdomen. The choice of total laparoscopic splenectomy according to the "hanged spleen" procedure was conditioned by the technical difficulty of performing conservative treatment due to the site of the upper pole of the enlarged lesions, adherent to the diaphragm in 3 cases, and by the presence of multiple trabeculated splenic cysts in 1 case. Laparoscopy was always completed and all patients obtained relief of their symptoms. When conservative treatment such as partial splenectomy or decapsulation may jeopardize the good outcome of the operation, the management of nonparasitic splenic cysts can be successfully achieved by total laparoscopic splenectomy.     

Laparoscopic decapsulation of congenital splenic cysts: a step forward in splenic preservation

Purpose

The aim of this study was to evaluate the role of laparoscopic decapsulation in the management of congenital splenic cysts in children.

Methods

Patients who presented over the last decade with congenital splenic cysts and were treated with laparoscopic decapsulation were reviewed retrospectively. The authors performed 4 procedures in 3 patients aged 10, 11 (and later 13), and 13 years. In all cases there was progressive enlargement of a single cyst, which lay in the upper pole of the spleen in 3 instances and in the lower pole in the fourth. Pneumoperitoneum was induced using the Veress needle technique, and 3 or 4 ports were utilized. Cysts were aspirated initially before marsupialization with excision of around two thirds of the cyst wall. Both endoshears and the harmonic scalpel were used with good hemostatic effect.

Results

All patients had a good outcome with cyst resolution on long-term follow-up using serial ultrasound scanning. The first patient (in 1993) remained 3 days as an in patient postoperatively, and the others stayed overnight only. One patient had a new cyst near the first 30 months after the initial procedure. This again was dealt with laparoscopically, with patient discharge the following day. There were no complications in the short or long term. Histology in all cases confirmed a simple epithelial cyst. Median follow-up was 2 years (range, 6 months to 8 years).

Conclusions

Our experience shows that laparoscopic decapsulation is an effective means of managing congenital splenic cysts and that both harmonic scalpel and endoshears are satisfactory dissecting instruments. Extensive marsupialization is probably unnecessary in these larger cysts, because long-term follow-up has shown no increased risk of recurrence after leaving a significant proportion of the cyst wall behind. This approach helps avoid major surgery in these cases.     

经腹腔镜开窗减压术治疗巨大非寄生虫性脾囊肿是有效的保脾术式

原发性脾囊肿是一种罕见的疾病,目前尚缺乏对该疾病的理想治疗方法的相关研究.大多数原发性脾囊肿是上皮性囊肿.近几年,腹腔镜脾脏外科手术普及率不断提高.该研究报告了关于经腹腔镜保脾手术治疗脾囊肿的相关经验.1996年至2006年间,作者治疗了11例有症状的非寄生虫性脾脏巨大囊肿病人.病人均诉左上腹涨满症状,触诊可扪及腹部包块.术前腹部超声及CT均已明确诊断.病人接受经腹腔镜脾脏囊肿部分切除术或脾脏囊肿开窗减压术.结果发现,7例病人为脾脏间皮囊肿,2例为脾脏表皮样囊肿,2例为脾脏假性囊肿,没有发现囊肿癌变.手术操作时间为62～85 min,无中转开腹.     

经腹腔镜开窗减压术治疗巨大非寄生虫性脾囊肿是有效的保脾术式

原发性脾囊肿是一种罕见的疾病,目前尚缺乏对该疾病的理想治疗方法的相关研究.大多数原发性脾囊肿是上皮性囊肿.近几年,腹腔镜脾脏外科手术普及率不断提高.该研究报告了关于经腹腔镜保脾手术治疗脾囊肿的相关经验.1996年至2006年间,作者治疗了11例有症状的非寄生虫性脾脏巨大囊肿病人.病人均诉左上腹涨满症状,触诊可扪及腹部包块.术前腹部超声及CT均已明确诊断.病人接受经腹腔镜脾脏囊肿部分切除术或脾脏囊肿开窗减压术.结果发现,7例病人为脾脏间皮囊肿,2例为脾脏表皮样囊肿,2例为脾脏假性囊肿,没有发现囊肿癌变.手术操作时间为62～85 min,无中转开腹.     

Laparoscopic partial splenectomy using radiofrequency ablation for nonparasitic splenic cysts in two children

Nonparasitic splenic cysts are uncommon lesions, for which partial splenectomy offers a definitive treatment while preserving splenic function. We report the use of radiofrequency energy for laparoscopic partial splenectomy to treat two children with nonparasitic splenic cysts by creating a 1-cm thick coagulated parenchyma resection plane, allowing bloodless splenic transection. This approach spares the need for blood transfusions, reduces hospital stay, and offers great promise for partial splenectomy in children.     

Laparoscopic partial splenectomies for true splenic cysts. A report of two cases

The goals of treatment for nonparasitic splenic cyst include elimination of the cyst and prevention of recurrence. We treated two cases of true splenic cysts by successfully performing partial splenectomies via a laparoscopic approach. Herein we describe the surgical technique used and tactical aspects. Laparoscopic partial splenectomies can be a definitive treatment for true splenic cysts in that they preserve splenic function and prevent recurrence.     

Laparoscopic marsupialization of postrenal transplantation lymphoceles

BACKGROUND AND PURPOSE: Clinically significant post-transplantation lymphoceles are not uncommon. Surgical marsupialization with internal peritoneal drainage is the treatment of choice. We describe the successful laparoscopic formation of a peritoneal window for post-transplantation lymphocele drainage as an effective and minimally invasive procedure. PATIENTS AND METHODS: Between August 1995 and September 2001, 135 consecutive renal transplantations were performed, and 9 patients developed clinically significant lymphoceles. Four of the nine patients were treated by laparoscopic drainage via a peritoneal window. Analysis of predisposing risk factors commonly associated with lymphoceles was performed. The surgical outcome was assessed. RESULTS: Laparoscopic drainage was successful in all patients. The average operative time was 40 minutes. The mean hospital stay was 1.5 days for patients undergoing laparoscopic drainage versus 5 days for those having open surgical drainage. Accidental division of the right native ureter occurred in one patient, which was identified intraoperatively. None of the patients had developed recurrence of lymphocele after a mean follow-up of 10.7 months (range 6-22) months. CONCLUSION: In patients with a clinically significant post-transplantation lymphocele of appropriate size and location, laparoscopic drainage is easy, safe, and effective. It decreases hospital stay and hastens convalescence.     

Laparoscopic unroofing of splenic cysts results in a high rate of recurrences

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.