Laparoscopic Unroofing of Giant Epidermic Splenic Cyst Close to the Hilum

Abstract

Introduction:

Splenic cysts are a rare condition. Their incidence is becoming more frequent due to the increasing use of abdominal imaging techniques and conservative management of splenic injury. ¹ Surgical treatment is recommended for cysts >5 cm or symptomatic due to their risk of hemorrhage, rupture, or infection. ^2,3 Laparoscopic splenectomy has been the standard approach for many splenic conditions, but recently, more studies are showing that splenic preservation is suitable and advisable for most of these conditions. ^4,5 The splenic role is becoming more relevant and should be preserved for as long as possible. ⁶ According to some authors, total splenectomy is indicated when the cyst is located inside the spleen or close to the hilum. ⁷ We describe a laparoscopic complete unroofing of a symptomatic giant splenic cyst located in the upper pole of the spleen and its hilum.

Materials and Methods:

The authors report the clinical case of a 34-year-old female. The patient attended the emergency department complaining about abdominal discomfort and pressure, early satiety, and breathing difficulties when exercising. The abdominal examination showed a palpable mass in the left upper quadrant. The CT scan showed a giant splenic cyst (15 × 14 cm) involving most of the spleen, mainly the upper pole and the hilum. The patient did not have any relevant medical history, including any previous abdominal trauma. The routine biochemical and hematological investigations were normal, including negative serology for Echinococcus.

Results:

The procedure was performed by laparoscopy with two 5-mm trocars and one 10-mm trocar. The camera was a 5 mm 30° scope. The operative time was 88 minutes. There were neither perioperative complications nor morbidity. The patient received intravenous analgesia first 24 hours and then orally. Patient started walking a few hours after the operation and eating soft diet after 24 hours. The patient's recovery was prompt and clinically uneventful. She presented normal follow-up for 6 months after the operation.

Conclusion:

Partial decapsulation of a giant splenic cyst close to the hilum appears feasible and was performed safely in our center. In our experience, cysts located close to the hilum can be managed safely by complete unroofing. Nonetheless, further cases have to be done to state the best surgical option in these particular cysts close to the splenic hilum.

Acknowledgment: Kate Yoon for her help recording the audio narration.

No competing financial interests exist.

Runtime of video: 3 mins 26 secs