Laparoscopic Splenic Cystectomy: A Rational Approach

Abstract

Purpose: Nonparasitic splenic cysts are uncommon and may be congenital or post-traumatic in origin. Complications may include enlargement with pain, rupture, and infection. Traditional management includes total or partial splenectomy, partial cystectomy with marsupialization, percutaneous drainage, and sclerotherapy. These techniques are associated with the undesirable consequences of splenic loss and cyst recurrence, especially in patients with congenital epithelial lined cysts. A technique designed to minimize the risk of splenic loss and cyst recurrence is presented. Methods: A 4-year-old and a 13-year-old presented with large splenic cysts measuring 5.4 and 5.7 cm, respectively. Symptoms included left upper quadrant pain and there was no history of trauma. Both patients were managed with laparoscopic partial cystectomy using the harmonic scalpel to divide the cyst wall at its junction with the spleen proper, followed by complete obliteration of the remaining intrasplenic cyst wall using the argon-beam coagulator. Results: Both patients had an uneventful postoperative course and were discharged home within 24 hours of surgery. Operative time was under one hour and blood loss was minimal. Pathology showed a congenital epithelial (mesothelial) cyst and a post-traumatic cyst, respectively. Conclusion: Laparoscopic partial splenic cystectomy with obliteration of remaining intrasplenic cyst wall can be performed safely. This technique preserves the spleen and minimizes the risk of recurrence, regardless of the origin of the cyst.