‘SALVAGING THE SPLEEN’ - A SPLEEN PRESERVING APPROACH IN SPLENIC CYSTS.
EAES Academy. Dharmadhikari S. 07/05/22; 363153; P198
Shalmali Dharmadhikari
Contributions
Contributions
Abstract
Background:
Cystic lesions of spleen can include parasitic and non-parasitic types. Parasitic cysts account for 50-80% of the splenic cysts, with the major contributor being echinococcal disease. Splenic hydatid cyst is an extremely rare entity, with a worldwide incidence of 0.5-4 %. Life threatening complications like anaphylaxis can present as an outcome of the silent disease process which can be easily missed out on radiological studies. Hence, hydatid disease of spleen should be considered as a differential in every patient in endemic areas of Mediterranean countries, Central Asia with cystic lesion of spleen until proven otherwise.
Splenectomy has always been the conventional management and since 1980 treatment has evolved from splenectomy to spleen preserving techniques. The immunological superiority of the spleen demands novel approaches for preservation of spleen.
Method:
At Grant Medical College, a total 55 cases of splenic cyst were operated involved both parasitic (40) and non-parasitic (15) lesion. In 47 cases spleen was conserved and 8 cases required total splenectomy. Out of 47 cases of spleen preserving surgeries performed 30 were parasitic and 17 non-parasitic. Patients were given Tab. Albendazole pre-operatively for 6 weeks. Spleen preservation with deroofing of cyst was done in all cases. 40 cases had solitary Splenic cyst (80%) and 10 cases had multiple splenic cyst (20%). The mean hospital stay was 7 days in uncomplicated cases and 14 days who required laparotomy.
Results:
Out of 50 cases operated via endoscopic approach, 2 cases were converted to open surgery (5%) due to massive splenic hemorrhage from pedicle. Post operatively, 12 patients (24%) had significant post-operative pain of VAS more than 5 on average persisting for more than 24 hours. While others had minimal post-op pain lasting for less than 6 hours. During a follow up period of 36 months no recurrences were seen.
Conclusions:
Splenic preservation is feasible, immunologically superior; with reduced pain, in hospital stay and early recovery of the patients. However meticulous dissection and careful addressal of tissue planes can reduce conversion rates.
Cystic lesions of spleen can include parasitic and non-parasitic types. Parasitic cysts account for 50-80% of the splenic cysts, with the major contributor being echinococcal disease. Splenic hydatid cyst is an extremely rare entity, with a worldwide incidence of 0.5-4 %. Life threatening complications like anaphylaxis can present as an outcome of the silent disease process which can be easily missed out on radiological studies. Hence, hydatid disease of spleen should be considered as a differential in every patient in endemic areas of Mediterranean countries, Central Asia with cystic lesion of spleen until proven otherwise.
Splenectomy has always been the conventional management and since 1980 treatment has evolved from splenectomy to spleen preserving techniques. The immunological superiority of the spleen demands novel approaches for preservation of spleen.
Method:
At Grant Medical College, a total 55 cases of splenic cyst were operated involved both parasitic (40) and non-parasitic (15) lesion. In 47 cases spleen was conserved and 8 cases required total splenectomy. Out of 47 cases of spleen preserving surgeries performed 30 were parasitic and 17 non-parasitic. Patients were given Tab. Albendazole pre-operatively for 6 weeks. Spleen preservation with deroofing of cyst was done in all cases. 40 cases had solitary Splenic cyst (80%) and 10 cases had multiple splenic cyst (20%). The mean hospital stay was 7 days in uncomplicated cases and 14 days who required laparotomy.
Results:
Out of 50 cases operated via endoscopic approach, 2 cases were converted to open surgery (5%) due to massive splenic hemorrhage from pedicle. Post operatively, 12 patients (24%) had significant post-operative pain of VAS more than 5 on average persisting for more than 24 hours. While others had minimal post-op pain lasting for less than 6 hours. During a follow up period of 36 months no recurrences were seen.
Conclusions:
Splenic preservation is feasible, immunologically superior; with reduced pain, in hospital stay and early recovery of the patients. However meticulous dissection and careful addressal of tissue planes can reduce conversion rates.
Background:
Cystic lesions of spleen can include parasitic and non-parasitic types. Parasitic cysts account for 50-80% of the splenic cysts, with the major contributor being echinococcal disease. Splenic hydatid cyst is an extremely rare entity, with a worldwide incidence of 0.5-4 %. Life threatening complications like anaphylaxis can present as an outcome of the silent disease process which can be easily missed out on radiological studies. Hence, hydatid disease of spleen should be considered as a differential in every patient in endemic areas of Mediterranean countries, Central Asia with cystic lesion of spleen until proven otherwise.
Splenectomy has always been the conventional management and since 1980 treatment has evolved from splenectomy to spleen preserving techniques. The immunological superiority of the spleen demands novel approaches for preservation of spleen.
Method:
At Grant Medical College, a total 55 cases of splenic cyst were operated involved both parasitic (40) and non-parasitic (15) lesion. In 47 cases spleen was conserved and 8 cases required total splenectomy. Out of 47 cases of spleen preserving surgeries performed 30 were parasitic and 17 non-parasitic. Patients were given Tab. Albendazole pre-operatively for 6 weeks. Spleen preservation with deroofing of cyst was done in all cases. 40 cases had solitary Splenic cyst (80%) and 10 cases had multiple splenic cyst (20%). The mean hospital stay was 7 days in uncomplicated cases and 14 days who required laparotomy.
Results:
Out of 50 cases operated via endoscopic approach, 2 cases were converted to open surgery (5%) due to massive splenic hemorrhage from pedicle. Post operatively, 12 patients (24%) had significant post-operative pain of VAS more than 5 on average persisting for more than 24 hours. While others had minimal post-op pain lasting for less than 6 hours. During a follow up period of 36 months no recurrences were seen.
Conclusions:
Splenic preservation is feasible, immunologically superior; with reduced pain, in hospital stay and early recovery of the patients. However meticulous dissection and careful addressal of tissue planes can reduce conversion rates.
Cystic lesions of spleen can include parasitic and non-parasitic types. Parasitic cysts account for 50-80% of the splenic cysts, with the major contributor being echinococcal disease. Splenic hydatid cyst is an extremely rare entity, with a worldwide incidence of 0.5-4 %. Life threatening complications like anaphylaxis can present as an outcome of the silent disease process which can be easily missed out on radiological studies. Hence, hydatid disease of spleen should be considered as a differential in every patient in endemic areas of Mediterranean countries, Central Asia with cystic lesion of spleen until proven otherwise.
Splenectomy has always been the conventional management and since 1980 treatment has evolved from splenectomy to spleen preserving techniques. The immunological superiority of the spleen demands novel approaches for preservation of spleen.
Method:
At Grant Medical College, a total 55 cases of splenic cyst were operated involved both parasitic (40) and non-parasitic (15) lesion. In 47 cases spleen was conserved and 8 cases required total splenectomy. Out of 47 cases of spleen preserving surgeries performed 30 were parasitic and 17 non-parasitic. Patients were given Tab. Albendazole pre-operatively for 6 weeks. Spleen preservation with deroofing of cyst was done in all cases. 40 cases had solitary Splenic cyst (80%) and 10 cases had multiple splenic cyst (20%). The mean hospital stay was 7 days in uncomplicated cases and 14 days who required laparotomy.
Results:
Out of 50 cases operated via endoscopic approach, 2 cases were converted to open surgery (5%) due to massive splenic hemorrhage from pedicle. Post operatively, 12 patients (24%) had significant post-operative pain of VAS more than 5 on average persisting for more than 24 hours. While others had minimal post-op pain lasting for less than 6 hours. During a follow up period of 36 months no recurrences were seen.
Conclusions:
Splenic preservation is feasible, immunologically superior; with reduced pain, in hospital stay and early recovery of the patients. However meticulous dissection and careful addressal of tissue planes can reduce conversion rates.
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