ORGAN-PRESERVING INTERVENTIONS IN SURGICAL CORRECTION OF SPLEEN CYSTS IN CHILDREN

Abstract

The surgical approach to splenic cyst treatment in children is rather controversial. There are different organ-preserving surgeries available to treat children with the spleen affected by cystic lesions. These surgical interventions are thoroughly discussed in various sources.
 The aim is to evaluate different options available for surgical treatment of splenic cysts in children.
 Material and Methods. The timeframe of the research involved a period from January 1998 to December 2020. Both medical examinations and treatment procedures of 265 children aged from 1 month to 18 years old, suffering from splenic cysts, were analyzed retrospectively. There were 175 patients (66.04%) who underwent surgery, while 90 individuals (33.96%) remained under dynamic observation.
 Results and Discussion. A total of 119 open surgeries (68.00%) and 56 minimally invasive surgeries (32.00%) were performed on cysts located in different areas. All surgical interventions were performed on children. The preferred type of open surgery entailed partial splenic resection. There were 71 patients (59.66%) who underwent the procedure. The cysts displayed the tendency to recur after laparotomy. This phenomenon was observed in 2 patients (1.68%). Another partial cystectomy was performed to correct the condition. The operation involved laparotomy-assisted capitonnage. Partial cystectomy was the preferred type of minimally invasive surgery. The following surgical intervention involved 30 children (53.57%). A number of 21 patients underwent cystectomy with capitonnage (37.50%), while 5 individuals (8.93%) had a partial splenic resection. Cysts recurred in 3 patients (5.36%) after laparoscopic intervention. Laparoscopic correction of the recurred cyst was performed on 1 patient, while the other 2 individuals underwent open surgeries. Over time, a minimal residual cyst cavity was observed in 9 children (7.56%) after open surgery. Having undergone minimally invasive surgery on splenic cysts, 7 patients (12.50%) suffered from a minimal residual cyst cavity, which healed on its own within 1-2 years.
 Conclusion. The type of surgery used to correct splenic cysts should fulfil the individual requirements of patients. The location, size, and structure of the major vessels must be considered. Splenic parenchyma must be thoroughly examined since it can be affected. Unroofing surgery can be performed while operating on children with SC if the location, size, and degree of parenchymal involvement are taken into consideration. Unroofing surgery should be accompanied by capitonnage to either close or decrease the volume of the residual cyst cavity. Partial splenic resection is performed through either laparoscopy or open surgery since blood supply of the spleen is vital. Partial splenic resection is a rational treatment method used for SC as it eradicates the above-mentioned pathology and preserves all essential functions of the spleen.