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Partial laparoscopic decapsulation of congenital splenic cysts. A medium-term evaluation proves the efficiency in
1Department of Pediatric Surgery, Children's Hospital, University of Munich, 4 Lindwurmstrasse, D-80337 Munich, Germany. holger.till@kk-i.med.uni-muenchen.de
Insights
Laparoscopic decapsulation effectively treats large congenital splenic cysts in children, preserving spleen tissue. This minimally invasive approach shows good medium-term results with no recurrence in observed patients.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Congenital splenic cysts in children can be large and symptomatic.
- Laparoscopic decapsulation is a potential treatment, but long-term data are limited.
- This study reports outcomes from two pediatric surgical centers.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of laparoscopic decapsulation for large congenital splenic cysts in children.
- To assess recurrence rates and splenic tissue preservation after the procedure.
Main Methods:
- Eight children with large splenic cysts (>4 cm) underwent laparoscopic decapsulation between 1998-2002.
- The procedure involved radical excision of the cyst's epithelial portion and coagulation of the hilar epithelium.
- Postoperative follow-up included regular ultrasounds to monitor for recurrence.
Main Results:
- All eight procedures were completed without major intraoperative complications.
- The mean operating time was 75 minutes.
- After a mean follow-up of 2.2 years, no patients showed evidence of recurrent cyst growth, and all had healthy splenic remnants.
Conclusions:
- Partial laparoscopic decapsulation is an effective and advantageous approach for large congenital splenic cysts in children.
- The technique preserves splenic tissue and yields good medium-term results.
- This minimally invasive method offers a safe and successful treatment option.
Background:
In children, laparoscopic decapsulation of large congenital splenic cysts has occasionally been advocated, but substantial series focusing on its long-term success are still lacking. We report the follow-up experiences from two pediatric surgical centers.
Methods:
The decision to proceed to surgery was based on patient symptoms and cyst size (>4 cm and/or progression), after strictly exclusion of a parasitic cause (by serology and CT scan). With the use of three ports (5-10-mm) and a Harmonic Scalpel, the epithelial portion of the cyst was radically excised. The remaining hilar epithelium was coagulated carefully. After discharge, the children were examined regularly by ultrasound to detect recurrences.
Results:
From 1998 until 2002, eight children (mean age, 11.1 years; range, 3.1-16.4) were treated for cysts ranging from 4 to 15 cm in diameter. All procedures were completed without significant intraoperative complications (no major bleeding, no conversions). The mean operating time was 75 min (range, 56-184). Postoperatively, one child developed a cystic remnant (2 cm), which remained unchanged during 30 months of observation. After a mean follow-up of 2.2 years (range, 13-38 months), none of the patients showed any evidence of recurrent growth, and all of them had healthy splenic remnants.
Conclusion:
Partial laparoscopic decapsulation is an advantageous approach to large splenic cysts in children, because it is effective, preserves splenic tissue, and provides good medium-term results.