Tactical approaches for the treatment of spleen cysts in children
DOI:
https://doi.org/10.15574/PS.2020.66.27Keywords:
spleen cyst, children, treatment, laparoscopy, laparotomy, resultsAbstract
Tactical approaches for the treatment of spleen cysts (SC) in children remains controversial. There are no clear guidelines for the treatment of SC in children, as published studies are based on a small number of patients.Aim: To develop rational tactical approaches for the treatment of SC in children.
Materials and methods. A retrospective analysis of the diagnosis and treatment of 265 children aged 1 month to 18 years with SC was performed. 175 (66.04%) children were operated. The remaining 90 (33.96%) patients were not operated, they were under dynamical observation.
Results. 119 (68.00%) open surgery and 56 (32.00%) laparoscopic interventions in children with different segmental localization of cysts were performed. Laparotomic partial cystectomy was performed in 12 patients, partial cystectomy with capitanization – in 36, partial resection of the spleen – in 70 and splenectomy (with total cystic lesion of the spleen) – in 1 child. Cyst recurrence after open SC correction was observed in 2 (1.68%) of 119 patients which were corrected by partial cystectomy with capitanization during open surgery. Laparoscopic partial cystectomy was performed in 30 patients, partial cystectomy with capitanization – 21 and partial resection of the spleen – in 5 children. In 3 (5.36%) of 56 patients, cystic recurrence was observed after laparoscopy. Which were corrected laparoscopically one case and in two children – open surgery. In 9 (7.56%) children after laparotomy and in 7 (12.50%) after laparoscopic correction of SC, in the postoperative period retained the minimal residual cavity of the cyst, which automatically healed (scared) in the dynamics follow up during 1-2 years.
Patients with SC with a diameter of less than 20 mm (n=61) were not operated. We did not observe any progression in the size of cyst in these children. We did not operate children with spleen cyst which was 20 to 62 mm in size, had asymptomatic clinical course, and parents did not agree for surgical treatment (n=29), and this group was less informative for monitoring and analysis.
Based on the results of our study, we proposed analgorithm for the treatment of SC in children.
Conclusions. The treatment of children with SC remains controversial. The individual choice of the method of surgical treatment of SC depends on the localization, size, relation to the architecture of the main vessels and variant lesions of the parenchyma of the spleen on the basis of radiological methods of diagnosis and experience gained.
Partial resection of the spleen was performed, taking into account its segmental blood supply by laparoscopic or open method is a rational method of treatment of SC, which radically eliminates the pathology and preserves all important functions of the spleen.
Laparoscopic treatment of SC in children has limited indications. Dynamic observation is rational with a SC up to 20 mm in diameter.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
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