Spleen preserving surgery for parasitic splenic lesion management and outcome: single institution experience


Sah S P, Gupta R K, Joshi B R, Agrawal CS

Abstract 

Background: Splenic cysts are rare clinical entity encountered in surgical practice. It has been classified into primary (true) and secondary (pseudo) cysts. Parasitic cysts are zoonotic disease caused by Echinococcus granulosus. The previous accepted standard of care was splenectomy, but the likelihood of developing overwhelming post splenectomy infection and sepsis, has pushed surgeons to adopt various techniques to preserve as much viable splenic tissue as possible and  so nowadays laparoscopic partial pericystectomy or partial spenectomy with preservation of the spleen are opted as surgical options. 

Objectives: To analyze the outcome and effectiveness of laparoscopic treatments and clinical manifestations of splenic hydatid cysts. 

Methods: Retrospectively, we reviewed fourteen patients who were operated laparoscopically for splenic hydatid cyst between july 2009 to june 2016 at B.P.Koirala Institute of Health Sciences Dharan, Nepal, over a period of seven years. We recorded the epidemiologic characteristics of the patients, their symptoms, physical examination findings, laboratory and radiographic investigations, surgical methods implemented, length of hospital stay, postoperative complications, further follow-up and recurrence. 

Results: The mean age was 35.5 years (range 22 - 58 years). Left hypochodrium pain with dragging sensation was the common symptom in 7 cases. Ten patients were managed with partial cystectomy with omentopexy, two patients were managed with partial splenectomy using harmonic device as energy source and two patients were managed with splenectomy. One patient developed recurrence after one year managed with open splenectomy. 

Conclusion: Management of a splenic hydatid cyst is not consensual. Total splenectomy is optimal because it provides definitive treatment. However, nowadays spleen-preserving surgery is the preferred treatment in some selected patients.

Key words: Splenic cysts, spleen preserving surgery, echinococcosis, partial cystectomy