Laparoscopic splenic cyst excision with a harmonic scalpel and glue agents in children

  • Mazzei A
  • Centonze A
  • Stranieri G
  • et al.
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We read with interest the recent article by Dan et al. 1 The article reports a rare case of a young adult woman presenting with a massive splenic cyst that was treated lapa-roscopically. With respect to the open approach (total or partial splenectomy), in laparoscopy the most common techniques are: fenestration, decapsulation, marsupializa-tion, and omental packing, which has a higher recurrence rate, as shown from the literature. 2 In 2002 Ultracision LaparoSonic coagulating shears were first introduced for laparoscopic decapsulation of an epi-dermoidal splenic cyst in a 10-year-old child, with encouraging results. 3 The advantages of using the harmonic scalpel (accuracy, less bleeding, speed) have subsequently been reported in literature, also in children, pointing out the importance of guaranteeing sufficient margins of healthy splenic tissue on the borders to avoid the risk of recurrence of bleeding. 4,5 Recently in our Division of Pediatric Surgery we treated a 16-year-old female who presented with a palpable abdominal mass in the upper left abdomen. Her past medical history was unremarkable. Laboratory findings and serology were negative. The ultrasonography demonstrated the presence of a splenic cyst and the computed tomog-raphy confirmed the sonographic data. In accord with recent literature, we decided on a laparoscopic elective approach, using the harmonic scalpel. After its complete removal, the surgical bed was treated with Tachosil (Nycomed), a fixed combination of a patch sponge coated with a dry layer of the human coagulation factors fibrinogen and thrombin. To reduce the risk of adhesions we did not perform omental patching. The histological exam revealed the presence of an epidermal cyst. The postoperative phase was uneventful. The 6-month follow-up did not reveal signs of recurrence. As reported by the previous authors, 1 we do not recommend open surgery as the first approach mainly for aesthetic reasons, likewise a simple aspiration or decapsulation can have a high recurrence rate. Laparoscopy integrated with the harmonic scalpel and glue agents could be the gold standard for treating this pathology, however a follow-up of 6 months appears to be too short to evaluate recurrences. In this respect, future multicenter studies with significant numbers are required. References 1




Mazzei, A., Centonze, A., Stranieri, G., Salerno, D., & Baldassarre, E. (2012). Laparoscopic splenic cyst excision with a harmonic scalpel and glue agents in children. Asian Journal of Surgery, 35(3), 123.

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