Rezecție laparoscopica a chistului lienal neparazitar

Abstract

Introduction: Nonparasitic splenic cysts are rarely disease, and may be congenital or post-traumatic in origin. Traditional management includes total or partial splenectomy, partial cystectomy with marsupialization, percutaneous drainage, and sclerotherapy. A laparoscopic technique used to minimize the risk of splenic loss and cyst recurrence is presented.In the current study, we aimed to evaluate the laparoscopic management of patients with nonparasitic splenic cysts together with their long term follow up progresses.Methods: The cases of 5 patients who underwent surgery for spleen cysts at our hospital over the last 12 years from 1998 to 2010 were analyzed. There are 1 male and 4 female. The mean age was 31 (25 - 36). Symptoms included left upper quadrant pain and there was no history of trauma. Diagnosis was based on ultrasonography (US), and computed tomography (CT) findings. The mean size of cysts was 12 (8 – 15) cm. All patients were managed with laparoscopic partial cystectomy using the diathermic monopolar cutting of the cyst wall and hemostasis by coagulation.Results: All patients had an noncomplicated postoperative course and were discharged home within 3 – 5 days. Operative time was 35 – 90 min., and blood loss was minimal. Pathology finding was a epithelial (mesothelial) cysts. One case (the second of) the operation was finished by laparoscopic splenectomy immediately after resection of the cyst. Decision for splenectomy was caused to marginal bleeding and insufficiency of experience in this kind of procedure. Consecutive follow up in 10 years showed the hyperplasia (6 cm. in diameter) of accessory spleen (initial 1cm. in diameter) in this patient. One patient underwent laparoscopic procedure repeat in two years, but in 3th procedure the spleen was removed because recurrence and infecting of the cyst. Conclusion: 1.Laparoscopic splenic cystectomy can be performed safely. 2.This technique preserves the spleen and minimizes the risk of recurrence of the cyst.