Original articleLaparoscopic unroofing of splenic cysts results in a high rate of 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
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