Elsevier

Journal of Pediatric Surgery

Volume 42, Issue 11, November 2007, Pages 1860-1863
Journal of Pediatric Surgery

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

https://doi.org/10.1016/j.jpedsurg.2007.07.012Get rights and content

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.

Section snippets

Materials and methods

This study deals exclusively with nonparasitic splenic cysts, that is, primary cysts (with epithelial lining, clear fluid) or secondary cysts (no lining, brown fluid). From January 1995 to December 2005, the pediatric surgical departments of the University Medical Centers of Mainz, Hannover, and Mannheim (Germany) treated 14 children with primary and secondary nonparasitic cysts laparoscopically (Fig. 1, Fig. 2). Preoperatively, 9 of the patients had vague symptoms of upper abdominal pain,

Results

There were no intraoperative complications, no unplanned splenectomies, and no blood transfusions. However, on follow-up between 6 and 12 months (median, 12 months) new (or recurrent) cysts had formed in 9 children (64%). The size of these recurrences was smaller than the original cyst in most cases; the largest are approximately 50% to 75% of the original size. In none did the recurrent cyst exceed the original cyst in size.

A recurrence was observed in the 3 children in whom the inner cyst

Discussion

Conventionally, in most instances, splenic cysts, if treated at all, were managed by laparotomy with total splenectomy. After the discovery of the dangers of overwhelming postsplenectomy infection, attempts were undertaken to preserve splenic parenchyma, and mere decapsulation of the cyst was suggested [1]. With the advent of laparoscopic surgery, partial decapsulation was quickly adopted by laparoscopists and subsequently published in a number of case reports [7], [8]. Some time elapsed until

References (16)

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