Laparoscopic Management of Benign Splenic Cysts in Children: Partial Splenectomy vs. Deroofing

Objectives: This study aimed to compare laparoscopic deroofing and laparoscopic partial splenectomy regarding recurrence, perioperative safety, and short-term postoperative outcomes in pediatric patients. Methods: This retrospective single-center study included pediatric patients who underwent laparoscopic partial splenectomy or laparoscopic deroofing for benign splenic cysts between January 2012 and August 2025. Demographics, cyst characteristics, operative variables, postoperative complications, and recurrence were analyzed. The primary outcome was cyst recurrence; secondary outcomes included duration of surgery and length of hospitalization. Results: Twenty-three patients met the inclusion criteria: 10 underwent laparoscopic partial splenectomy and 13 laparoscopic deroofing. Groups were comparable in age, sex distribution, cyst diameter, body mass index, and American Society of Anesthesiologists classification (all p > 0.3). No conversions to open surgery occurred. Operative time was significantly shorter for partial splenectomy (37.8 ± 7.1 min) compared with deroofing (77.3 ± 33.6 min; p = 0.001). Length of hospitalization did not differ significantly between groups (median 2 days; p = 0.596). Two minor postoperative complications occurred in the deroofing group, without a significant difference between techniques (p = 0.486). A striking difference in recurrence was observed: no recurrences occurred after partial splenectomy (0%), whereas recurrence was documented in 8/13 patients (61.5%) after deroofing (p = 0.003). Conclusions: Laparoscopic partial splenectomy offers superior long-term efficacy in treating benign splenic cysts in children, with significantly lower recurrence rates and shorter operative times than laparoscopic deroofing. While deroofing remains a technically accessible option, its high recurrence rate limits its role as a definitive treatment. Partial splenectomy appears to be the preferred spleen-preserving technique. Future prospective, multicenter, and ideally randomized studies are warranted to confirm these findings.