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RESULTS OF PEDIATRIC LAPAROSCOPIC SPLENIC CYST UNROOFING
Monica Langer1, Jordan Gutweiler2, Tom Jaksic2
1University of British Columbia, Vancouver, BC, Canada2Children's Hospital Boston, Harvard University, Boston, MA

Objective: Controversy exists regarding the appropriate surgical management of splenic cysts. This study sought to determine the radiologic and clinical consequences of laparoscopic splenic cyst unroofing in pediatric patients.
Design: Review of a case series with an IRB-approved chart review. Long-term follow-up was then conducted by telephone survey. Paired t-tests were used for pre and post operative comparisons. Results expressed as mean ± S.D.
Setting: Tertiary care pediatric referral hospital
Patients: Consecutive series of patients who had laparoscopic splenic cyst unroofing from 1998-2005. Thirteen patients, mean age 13.7 ± 3.4 years (range 7 - 18), were treated by laparoscopic unroofing for symptomatic (n=10) or large (diameter of > 7cm) (n=3) non-echinococcal splenic cysts.
Interventions: Laparoscopic splenic cyst unroofing, follow-up survey
Main Outcome Measure (s): Post-operative splenic cyst size, peri-operative morbidity, and presence of post-operative symptoms were the main outcome measures.
Results: Operative management resulted in a significant reduction in cyst size (11.1 ± 5.5 cm vs. 2.2 ± 3.2 cm, p=0.0001). Re-laparoscopy to rule out splenic bleeding was the sole peri-operative complication. After an average follow-up of 2.8 ± 1.6 years, 5/13 (38%) of patients demonstrated recurrent cysts upon subsequent imaging. One patient with persistent discomfort and increasing cyst size required repeat laparoscopic unroofing and did well subsequently.
Conclusions: Pediatric patients with symptomatic or large non-echinococcal splenic cysts may be treated effectively and safely with laparoscopic unroofing. Although a substantial number of patients evolve small recurrent cysts they are usually asymptomatic and rarely require repeat operative intervention.


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