Laparoscopic ligation of splenic artery aneurysms: report of two cases and literature overview

Coexisting giant splenic artery aneurysm and non-functioning pancreatic neuroendocrine tumor

The splenic artery aneurysm (SAA) is rare clinical entity which is the third most common intra-abdominal aneurysm. Pancreatic neuroendocrine tumors (pNETs) are rare malignancies which comprise less than 2% of all pancreatic tumors. Non-functioning pancreatic neuroendocrine tumors set forth up to 90% of all PNETs. Sixty-seven-year-old female presented to our polyclinic with increasing pain in the left upper quadrant in the previous three months. A computed tomographic angiography revealed 13x13x12 cm sized regular bounded aneurysmatic expansion of medium part of splenic artery. In addition there was a 8x7 mm sized hypoecoic lesion in the distal pancreatic tissue. Distal pancreatectomy, splenic aneurysm resection and splenectomy was performed. Pathological results revealed that there was a 12 cm sized giant true splenic aneurysm and 0.7 cm sized neuroendocrine tumor in the pancreatic tissue. This manuscript is presentation of surgical approach to a case with coexistence of these two rare conditions.

Laparoscopic approach to splenic aneurysms

Background Splenic artery aneurysm is a rare disease with possibly mortal complications. For years, the main method of treatment was excision of aneurysm with spleen. In recent years, several methods have been developed in order to salvage the spleen such endovascular techniques and aneurysmectomy. Objective The aim of our study was to determine the feasibility of laparoscopic aneurysmectomy with spleen salvage in cases of splenic artery aneurysm. Materials Analysis of prospectively gathered data containing records of patients operated laparoscopically due to diseases of the spleen in 1998-2016 in our department. Inclusion criteria were attempted laparoscopic aneurysmectomy with intent to salvage spleen. Results Out of 11 patients, seven patients underwent aneurysmectomy with spleen preservation, one patient had partial-splenectomy, two patients had intra-operative splenectomies and one patient had a re-operation on post-op day 1 with splenectomy. Re-operation with splenectomy was the only recorded complication. Conclusions Laparoscopic aneurysmectomy of SAA may be considered as a safe treatment method, with good short- and long-term results; however, a complete evaluation requires further research on a larger study group. It allows permanent treatment of SAA with maintaining spleen function.

Laparoscopic splenic artery ligation for hypersplenism in cirrhosis: A case series

BACKGROUND:

Splenectomy for the treatment of hypersplenism in patients with cirrhosis (HIC) is related with complications. Laparoscopic splenic artery ligation (LSAL) may be an alternative treatment option.

AIMS:

To evaluate safety and feasibility of LSAL in the treatment of HIC.

PATIENTS AND METHODS:

Retrospective analysis of prospectively collected data of ten patients with HIC who were treated with LSAL from October 2012 to February 2015.

RESULTS:

The median (range) age was 33.2 (13-56) years and sex distribution was equal. The median (range) leukocyte counts (×10⁹/L) before, and at 3, 6 and 12 months after LSAL were 2.2 (0.8-8.2) and 5.65 (2.78-10.7), 4.7 (2.8-7.8) and 4.95 (3.4-7.7) respectively. The median (range) platelet counts (×10⁹/L) before and at 3, 6 and 12 months after LSAL were 25.5 (11-65) and 75 (39-289), 74 (32-184) and 76 (56-251) respectively. Following LSAL, there was a significant improvement in total leucocyte count, platelet count and Model for End-Stage Liver Disease (MELD) score (P < 0.05). Two patients (20%) developed intraoperative bleeding and required conversion; one of these two patients developed splenic cyst that required radiological intervention. Four patients (40%) had post ligation syndrome (PLS) that was managed conservatively. During a median (range) follow-up of 19.5 (5-29) months, one patient (10%) required splenectomy due to inadequate response.

CONCLUSION:

LSAL is a safe and feasible treatment option for the palliation of symptomatic HIC, however, further prospective trials are necessary for confirmation.