The effectiveness of surgical treatment of children with non-parasitic cysts of the spleen

Abstract

From 2000 to 2017 49 children 2 - 17 years-old with non-parasitic cysts of the spleen sizes from 4 to 16 cm were treated by surgery. Preoperative examination included ultrasonography, multislpiral computer tomography, magnetic resonance imaging and angiography. The various types of surgical treatment were used. Thus, 27 children underwent percutaneous drainage of the cyst using ultrasound navigation, deepitelisation was carried out by introducing into the cavity of 95% ethanol with exposure 7 - 8 minutes. In 16 patients was additionally used superselective embolization of the arteries that supply the wall of the cyst. In 2 cases procedure was limited to puncture and alcoholisation of cysts without remain drainage due to small residual cavities. 3 children with subcapsular localization of cysts have been subjected the laparoscopic fenestration with deepitalisation by high-temperature plasma stream. After that procedures the residual cavities was filled with PerClot, which is in contact with the liquid turned into a gel. In the early postoperative period the PerClot was visualized in the form of multiple hyperechogenic inclusions up to 3mm. Within 30 days these acoustic changes have disappeared without the formation of cavities. Among all patients subcapsular hematoma of the spleen after percutaneous puncture was noted in 2 cases (4%), recurrence of the cyst was diagnosed in 1 child (2%). Conclusion: minimally invasive technologies in surgical treatment of children with non-parasitic cysts of the spleen allow us to completely abandon laparotomy and splenectomy, even at larger sizes cysts.