Abstract
Introduction:
Laparoscopic partial splenectomy (LPS) theoretically preserves long-term immune functions of the spleen. This video presentation aimed at testing the feasibility of LPS in avoidance of sacrificing the entire spleen in children with focal splenic lesions.
Patients and Methods:
Case no. 1: A 3-year-old boy presenting with persistent anorexia with intermittent gastric vomiting and constipation of unknown etiology. MRI abdomen revealed a lower pole exophytic focal splenic lesion measuring 6 cm in diameter displaying an intermediate signal on T1 and T2. LPS was done for him, with piecemeal specimen retrieval through minimal extension of 12 mm port site. Pathological examination revealed proliferating spindle cells with inflammatory infiltrate of lymphocytes, plasma cells, eosinophils, and histiocytes in a background of abundant blood vessels. Adjacent splenic tissue showed congestion. Picture is suggestive of inflammatory myofibroblastic tumor. Case no. 2: A 12-year-old girl presented with left hypochondrial pain of 6 months duration, with a palpable lower pole of spleen. Abdominal ultrasound and postcontrast CT abdomen revealed a large splenic cyst measuring 8 × 11 cm, probably hydatid cyst, confined to the lower pole of spleen. LPS was done for her, with Pfannenstiel incision for specimen retrieval. Gross examination of the specimen revealed a 13 × 9 cm partial splenectomy, with intact capsule and preserved notch, near totally replaced by a cyst with trabeculated smooth lining with surrounding splenic congestion. Microscopic examination revealed splenic tissue containing cyst, lined by cuboidal epithelium and showing fibrocollagenous wall, a picture of epithelial cyst. No abdominal drains were inserted by the end of operation in both cases. Length of hospital stay was 48 hours for both. No complications were reported at early postoperative follow-up.
Results and Conclusion:
LPS in children with polar splenic lesions proved to be a feasible minimally invasive approach that abides the risk for postsplenectomy sepsis. Extended follow-up and larger series are recommended for a firm conclusion.
No competing financial interests exist.
Runtime of video: 6 mins 23 secs
Presented at the Egyptian Pediatric Surgical Association meeting in November 2018.
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