A ten-year experience with laparoscopic treatment of splenic cysts.

BACKGROUND AND OBJECTIVES: The management of symptomatic splenic cysts lacks clear, evidence-based guidelines due to its low incidence. Recently, laparoscopic treatment has been described. We present our experience with the laparoscopic management of solitary splenic cysts with a review of the existing literature, and recommendations for therapy. METHODS: All patients who underwent laparoscopic treatment of splenic cysts over a 10-year period were identified. The medical records of these 9 patients were reviewed. RESULTS: All surgeries were performed laparoscopically, with no conversions. Two patients underwent cyst decapsulation, and 7 patients underwent cyst unroofing. No major complications occurred. Recurrence occurred in 33.3% of patients; unroofing had a recurrence rate of 42.9% compared with 0% after decapsulation. Pseudocysts were found in 66.7% of patients and true cysts on final pathology were found in 33.3%. CONCLUSIONS: Laparoscopic decapsulation and unroofing of splenic cysts are safe procedures that confer the advantages of both splenic preservation and minimally invasive surgery. Cyst unroofing has a high recurrence and should be selectively used. Laparoscopic cyst decapsulation is associated with longer operative time, but should be considered as first-line therapy.