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Laparoscopic partial splenectomy for splenic hemangioma: experience of a single center in six cases.

Han XL, Zhao YP, Chen G, Wu WM, Dai MH - Chin. Med. J. (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China.

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Despite a higher incidence of postoperative complications, splenectomy is a commonly performed procedure for splenic space-occupying lesions... A retrospective analysis of 2796 splenectomy patients showed that 119 patients (4.25%) had postoperative bacterial infections, and 71 (60%) died due to infections... Therefore, emphasis on the preservation of splenic function has been raised that is, at least 25% of the spleen's weight must be retained to maintain splenic immunologic functions, with the prerequisite of adequate arterial blood supply... If the tumor was large, not localized within the upper or lower pole, an irregular partial resection was performed along the edge of the mass after the dissection of the vessels dominating the corresponding polar... The transection of the spleen was performed after exposing the splenic artery by dissection of posterior peritoneum at the superior border of the pancreas and temporarily occluding it in order to reduce the bleeding of the wound... Large hemangioma is at high risk of hemorrhage due to possible rupture... Despite the successful treatment with embolization of the specific splenic arterial branch to the hemangioma or with radiotherapy and with antiangiogenic therapy, the best results are achieved with splenectomy either by laparotomy or laparoscopy... Laparoscopy, with the significant advantages of less trauma, clear exposure and quick postoperative recovery in contrast to the open partial splenectomy, requires surgeons to have quite skilled experience in upper abdominal laparoscopic surgery and to be quite familiar with the anatomy of the splenic hilar vessels... So we presumed that some chronic inflammation had existed around the tumor and spleen for a long time, resulted in the tight adhesions... That was a warning for us when we faced the situation like this, it was necessary to consider the balance of risk and benefit... If the dissection is difficult, the laparotomy should be performed without delay... The pursuit of the minimally invasive incision would result in inner large trauma such as massive hemorrhage, which should not be encouraged... In conclusion, laparoscopic partial splenectomy is safe for patients with the splenic hemangioma, but it is necessary to consider the size and location of the tumor and the conditions of the patients.

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The solid mass in the upper and intermediate pole of the spleen revealed by preoperative magnetic resonance imaging and clearly visible position of the vessels dominating the tumor relative to hilar vessels (upper two panels). (a) The mass was located in the upper and intermediate pole of the spleen in exogenous growth. (b) The Hilar vessels dominating the position where the mass was located were severed and occluded after being crippled, disposable isolated splenic vascular tumor site after clipping off. (c) An ischemic demarcation line appeared (arrow). (d) The mass and part of normal spleen were resected along the ischemia line. (e) No active bleeding in the wound after the resection. (f) The wound was treated by medical adhesive bandages and hemostatic gauze.
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Figure 1: The solid mass in the upper and intermediate pole of the spleen revealed by preoperative magnetic resonance imaging and clearly visible position of the vessels dominating the tumor relative to hilar vessels (upper two panels). (a) The mass was located in the upper and intermediate pole of the spleen in exogenous growth. (b) The Hilar vessels dominating the position where the mass was located were severed and occluded after being crippled, disposable isolated splenic vascular tumor site after clipping off. (c) An ischemic demarcation line appeared (arrow). (d) The mass and part of normal spleen were resected along the ischemia line. (e) No active bleeding in the wound after the resection. (f) The wound was treated by medical adhesive bandages and hemostatic gauze.

Mentions: Six patients (3 males and 3 females) aged from 30 to 47 years old (mean 39.7 years old) at Peking Union Medical College Hospital from August 2012 to June 2013 were included in this study. One patient complained of upper left abdominal pain. The others presented no obvious symptoms but were diagnosed with splenic space-occupying lesions by physical examination during clinical visits. Five patients who had solid heterogeneous tumors with abundant blood supply were considered as highly-possible hemangiomas prior to the surgery. They underwent surgeries shortly after the detection of the tumors. One patient, who had cystic lesion revealed by imaging, underwent a surgery after a 2 years follow-up due to the increase of the lesion size. All patients were examined by enhanced computed tomography (CT) or magnetic resonance imaging (MRI) to verify the nature of the mass and its relationship with the neighboring tissues, especially the relationship between the hilar vessels of the spleen and the mass as well as the residual spleen [Figure 1]. The inclusion criteria were as follows: having solid mass or cystic mass in the spleen (benign lesions revealed by preoperative CT or MRI) with an increase in size. Patients with malignant space-occupying lesion (primary or metastatic) in the spleen were excluded.


Laparoscopic partial splenectomy for splenic hemangioma: experience of a single center in six cases.

Han XL, Zhao YP, Chen G, Wu WM, Dai MH - Chin. Med. J. (2015)

The solid mass in the upper and intermediate pole of the spleen revealed by preoperative magnetic resonance imaging and clearly visible position of the vessels dominating the tumor relative to hilar vessels (upper two panels). (a) The mass was located in the upper and intermediate pole of the spleen in exogenous growth. (b) The Hilar vessels dominating the position where the mass was located were severed and occluded after being crippled, disposable isolated splenic vascular tumor site after clipping off. (c) An ischemic demarcation line appeared (arrow). (d) The mass and part of normal spleen were resected along the ischemia line. (e) No active bleeding in the wound after the resection. (f) The wound was treated by medical adhesive bandages and hemostatic gauze.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834785&req=5

Figure 1: The solid mass in the upper and intermediate pole of the spleen revealed by preoperative magnetic resonance imaging and clearly visible position of the vessels dominating the tumor relative to hilar vessels (upper two panels). (a) The mass was located in the upper and intermediate pole of the spleen in exogenous growth. (b) The Hilar vessels dominating the position where the mass was located were severed and occluded after being crippled, disposable isolated splenic vascular tumor site after clipping off. (c) An ischemic demarcation line appeared (arrow). (d) The mass and part of normal spleen were resected along the ischemia line. (e) No active bleeding in the wound after the resection. (f) The wound was treated by medical adhesive bandages and hemostatic gauze.
Mentions: Six patients (3 males and 3 females) aged from 30 to 47 years old (mean 39.7 years old) at Peking Union Medical College Hospital from August 2012 to June 2013 were included in this study. One patient complained of upper left abdominal pain. The others presented no obvious symptoms but were diagnosed with splenic space-occupying lesions by physical examination during clinical visits. Five patients who had solid heterogeneous tumors with abundant blood supply were considered as highly-possible hemangiomas prior to the surgery. They underwent surgeries shortly after the detection of the tumors. One patient, who had cystic lesion revealed by imaging, underwent a surgery after a 2 years follow-up due to the increase of the lesion size. All patients were examined by enhanced computed tomography (CT) or magnetic resonance imaging (MRI) to verify the nature of the mass and its relationship with the neighboring tissues, especially the relationship between the hilar vessels of the spleen and the mass as well as the residual spleen [Figure 1]. The inclusion criteria were as follows: having solid mass or cystic mass in the spleen (benign lesions revealed by preoperative CT or MRI) with an increase in size. Patients with malignant space-occupying lesion (primary or metastatic) in the spleen were excluded.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Despite a higher incidence of postoperative complications, splenectomy is a commonly performed procedure for splenic space-occupying lesions... A retrospective analysis of 2796 splenectomy patients showed that 119 patients (4.25%) had postoperative bacterial infections, and 71 (60%) died due to infections... Therefore, emphasis on the preservation of splenic function has been raised that is, at least 25% of the spleen's weight must be retained to maintain splenic immunologic functions, with the prerequisite of adequate arterial blood supply... If the tumor was large, not localized within the upper or lower pole, an irregular partial resection was performed along the edge of the mass after the dissection of the vessels dominating the corresponding polar... The transection of the spleen was performed after exposing the splenic artery by dissection of posterior peritoneum at the superior border of the pancreas and temporarily occluding it in order to reduce the bleeding of the wound... Large hemangioma is at high risk of hemorrhage due to possible rupture... Despite the successful treatment with embolization of the specific splenic arterial branch to the hemangioma or with radiotherapy and with antiangiogenic therapy, the best results are achieved with splenectomy either by laparotomy or laparoscopy... Laparoscopy, with the significant advantages of less trauma, clear exposure and quick postoperative recovery in contrast to the open partial splenectomy, requires surgeons to have quite skilled experience in upper abdominal laparoscopic surgery and to be quite familiar with the anatomy of the splenic hilar vessels... So we presumed that some chronic inflammation had existed around the tumor and spleen for a long time, resulted in the tight adhesions... That was a warning for us when we faced the situation like this, it was necessary to consider the balance of risk and benefit... If the dissection is difficult, the laparotomy should be performed without delay... The pursuit of the minimally invasive incision would result in inner large trauma such as massive hemorrhage, which should not be encouraged... In conclusion, laparoscopic partial splenectomy is safe for patients with the splenic hemangioma, but it is necessary to consider the size and location of the tumor and the conditions of the patients.

Show MeSH
Related in: MedlinePlus