World Journal of Surgery

, Volume 42, Issue 11, pp 3543–3550 | Cite as

Splenic Cysts: A Strong Indication for a Minimally Invasive Partial Splenectomy. Could the Splenic Hilar Vasculature Type Hold a Defining Role?

  • Simona Manciu
  • Stefan Tudor
  • Catalin VasilescuEmail author
Original Scientific Report



The aim of the study is to assess the impact of the splenic hilar vasculature configuration on the amount of remnant splenic parenchyma volume after partial splenectomy for splenic cysts.


The data of all patients receiving a splenectomy for a splenic cyst from 2002 to 2016 at the Center of General Surgery and Liver Transplantation of Fundeni Clinical Institute were retrospectively reviewed. The size and location in the splenic parenchyma of the cyst and the splenic hilar vasculature type were assessed for each patient with a splenectomy.


Thirty-one patients with non-parasitic and 32 patients with hydatid cysts were recorded. In cases of centrally located cysts, a total splenectomy was performed for the majority of cases, while in peripheral cysts a spleen-preserving surgery was feasible for most of the patients (p = 0.001). The size of the cyst was significantly higher in the group of patients with a total splenectomy, compared with the group with a partial splenectomy (p = 0.003). In the subgroup with a distributed arterial pattern, preservation of more than 50% of the initial parenchyma was achieved in a significantly higher proportion of patients, compared with the subgroup of patients with a magistral pattern (p = 0.012).


Besides cyst size or peripheral location in the splenic parenchyma, the vascular pattern is also considered another decisive factor that associates with successful conservative or minimally invasive approach.


  1. 1.
    Brunicardi FC, Schwartz SI (2005) Schwartz’s principles of surgery. McGraw-Hill, New YorkGoogle Scholar
  2. 2.
    Ackerman LV, Rosai J (2004) Rosai and Ackerman’s surgical pathology. Mosby, New YorkGoogle Scholar
  3. 3.
    Hansen MB, Moller AC (2004) Splenic cysts. Surg Laparosc Endosc Percutan Tech 14:316–322CrossRefGoogle Scholar
  4. 4.
    McColl RJ, Hochman DJ, Sample C (2007) Laparoscopic management of splenic cysts: marsupialization, cavity lining with surgicel and omentopexy to prevent recurrence. Surg Laparosc Endosc Percutan Tech 17:455–458CrossRefGoogle Scholar
  5. 5.
    Hamamci EO, Besim H, Korkmaz A (2004) Unusual locations of hydatid disease and surgical approach. ANZ J Surg 74:356–360CrossRefGoogle Scholar
  6. 6.
    Smith ST, Scott DJ, Burdick JS et al (2001) Laparoscopic marsupialization and hemisplenectomy for splenic cysts. J Laparoendosc Adv Surg Tech A 11:243–249CrossRefGoogle Scholar
  7. 7.
    Tiron A, Vasilescu C (2008) Role of the spleen in immunity. Immunologic consequences of splenectomy. Chirurgia (Bucur) 103:255–263Google Scholar
  8. 8.
    Vasilescu C, Stanciulea O, Tudor S et al (2006) Laparoscopic subtotal splenectomy in hereditary spherocytosis: to preserve the upper or the lower pole of the spleen? Surg Endosc 20:748–752CrossRefGoogle Scholar
  9. 9.
    Tomulescu V, Stanciulea O, Balescu I et al (2009) First year experience of robotic-assisted laparoscopic surgery with 153 cases in a general surgery department: indications, technique and results. Chirurgia (Bucur) 104:141–150Google Scholar
  10. 10.
    Vasilescu C, Popescu I (2008) Robotic surgery–possibilities and perspectives. Chirurgia (Bucur) 103:9–11Google Scholar
  11. 11.
    Yan Q, Zhu J, Zhan X et al (2013) Primary versus secondary splenic pedicle dissection in laparoscopic splenectomy for splenic diseases. J Am Coll Surg 216:266–271CrossRefGoogle Scholar
  12. 12.
    Till H, Schaarschmidt K (2004) Partial laparoscopic decapsulation of congenital splenic cysts. A medium-term evaluation proves the efficiency in children Surg Endosc 18:626–628PubMedGoogle Scholar
  13. 13.
    Matsumoto S, Mori T, Miyoshi J et al (2015) Huge splenic epidermoid cyst with elevation of serum CA19-9 level. J Med Invest 62:89–92CrossRefGoogle Scholar
  14. 14.
    Yoh T, Wada S, Kobayashi A et al (2013) Laparoscopic splenectomy for a large multilocular splenic cyst with elevated CA19-9: report of a case. Int J Surg Case Rep 4:319–321CrossRefGoogle Scholar
  15. 15.
    Ganti AL, Sardi A, Gordon J (2002) Laparoscopic treatment of large true cysts of the liver and spleen is ineffective. Am Surg 68:1012–1017PubMedGoogle Scholar
  16. 16.
    Szczepanik AB, Meissner AJ (2009) Partial splenectomy in the management of nonparasitic splenic cysts. World J Surg 33:852–856. CrossRefPubMedGoogle Scholar
  17. 17.
    Culafic DM, Kerkez MD, Mijac DD et al (2010) Spleen cystic echinococcosis: clinical manifestations and treatment. Scand J Gastroenterol 45:186–190CrossRefGoogle Scholar
  18. 18.
    Diaconescu MR, Glod M, Costea I et al (2008) Laparoscopic hand-assisted splenectomy for hydatid cyst. Chirurgia (Bucur) 103:103–106Google Scholar
  19. 19.
    Bodner J, Lucciarini P, Fish J et al (2005) Laparoscopic splenectomy with the da Vinci robot. J Laparoendosc Adv Surg Tech A 15:1–5CrossRefGoogle Scholar
  20. 20.
    Vasilescu C, Stanciulea O, Tudor S (2012) Laparoscopic versus robotic subtotal splenectomy in hereditary spherocytosis. Potential advantages and limits of an expensive approach. Surg Endosc 26:2802–2809CrossRefGoogle Scholar
  21. 21.
    Michels NA (1948) Variations in the blood-supply of the liver, gall bladder, stomach, duodenum, pancreas and spleen; 200 dissections. Am J Med Sci 216:115PubMedGoogle Scholar
  22. 22.
    Gianom D, Wildisen A, Hotz T et al (2003) Open and laparoscopic treatment of nonparasitic splenic cysts. Dig Surg 20:74–78CrossRefGoogle Scholar
  23. 23.
    Losanoff JE, Richman BW, Jones JW (2002) Nonparasitic splenic cysts. J Am Coll Surg 195:437–438 (author reply 438) CrossRefGoogle Scholar
  24. 24.
    Kumar N, Patil J, Swamy RS et al (2014) Atypical arterial supply to the spleen by polar branches of splenic artery and accessory splenic artery—a case report. J Clin Diagn Res 8:AD03–AD04PubMedPubMedCentralGoogle Scholar
  25. 25.
    Mertens J, Penninckx F, DeWever I et al (2007) Long-term outcome after surgical treatment of nonparasitic splenic cysts. Surg Endosc 21:206–208CrossRefGoogle Scholar
  26. 26.
    Eris C, Akbulut S, Yildiz MK et al (2013) Surgical approach to splenic hydatid cyst: single center experience. Int Surg 98:346–353CrossRefGoogle Scholar
  27. 27.
    Atmatzidis K, Papaziogas B, Mirelis C et al (2003) Splenectomy versus spleen-preserving surgery for splenic echinococcosis. Dig Surg 20:527–531CrossRefGoogle Scholar
  28. 28.
    Vasilescu C, Tudor S, Popa M et al (2010) Robotic partial splenectomy for hydatid cyst of the spleen. Langenbecks Arch Surg 395:1169–1174CrossRefGoogle Scholar
  29. 29.
    Rasheed K, Zargar SA, Telwani AA (2013) Hydatid cyst of spleen: a diagnostic challenge N. Am J Med Sci 5:10–20CrossRefGoogle Scholar
  30. 30.
    Akbulut S, Sogutcu N, Eris C (2013) Hydatid disease of the spleen: single-center experience and a brief literature review. J Gastrointest Surg 17:1784–1795CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Simona Manciu
    • 1
    • 2
  • Stefan Tudor
    • 1
  • Catalin Vasilescu
    • 1
    • 2
    Email author
  1. 1.Department of General Surgery and Liver TransplantationFundeni Clinical InstituteBucharestRomania
  2. 2.“Carol Davila” University of Medicine and PharmacyBucharestRomania

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