Laparoscopic decapsulation of XXXX : a step forward in splenic preservation.

@entity1 @entity516 @entity45
PURPOSE: The aim of this study was to evaluate the role of laparoscopic decapsulation in the management of @entity45 in @entity1 . METHODS: @entity1 who presented over the last decade with @entity45 and were treated with laparoscopic decapsulation were reviewed retrospectively. The authors performed 4 procedures in 3 @entity1 aged 10, 11 (and later 13), and 13 years. In all cases there was progressive enlargement of a single cyst, which lay in the upper pole of the spleen in 3 instances and in the lower pole in the fourth. @entity516 was induced using the Veress needle technique, and 3 or 4 ports were utilized. Cysts were aspirated initially before marsupialization with excision of around two thirds of the cyst wall. Both endoshears and the harmonic scalpel were used with good hemostatic effect. RESULTS: All @entity1 had a good outcome with cyst resolution on long-term follow-up using serial ultrasound scanning. The first @entity1 (in 1993) remained 3 days as an in @entity1 postoperatively, and the others stayed overnight only. One @entity1 had a new cyst near the first 30 months after the initial procedure. This again was dealt with laparoscopically, with @entity1 discharge the following day. There were no complications in the short or long term. Histology in all cases confirmed a simple epithelial cyst. Median follow-up was 2 years (range, 6 months to 8 years). CONCLUSIONS: Our experience shows that laparoscopic decapsulation is an effective means of managing @entity45 and that both harmonic scalpel and endoshears are satisfactory dissecting instruments. Extensive marsupialization is probably unnecessary in these larger cysts, because long-term follow-up has shown no increased risk of recurrence after leaving a significant proportion of the cyst wall behind. This approach helps avoid major surgery in these cases.
