Laparoscopic approach to splenic aneurysms

Abstract

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.

Successful use of resuscitative endovascular balloon occlusion of the aorta in the treatment of ruptured 8.5-cm splenic artery aneurysm

“…Alternative treatments include endovascular approaches with transcatheter embolization. 2,[7][8][9][10][11][12] REBOA is a minimally invasive technique using a balloon catheter to temporarily occlude the aorta in support of hemorrhage control. It provides proactive management of life-threatening, refractory hemorrhagic shock despite maximal conventional therapy and is potentially lifesaving with minimal complications when placed by trained providers.…”

Laparoscopic splenectomy in the treatment of splenic artery aneurysm - case report and literature review

“…SAA is defined as a segmental enlargement of the artery with a diameter of 10 mm. SAA rupture is a life-threatening condition with a mortality rate of up to 75% [1,12].…”

“…In symptomatic patients, the most common complaints are epigastric or back pain. Some authors consider that all symptomatic patients, as well as patients with no symptoms, whose SAA is > 20 mm in diameter, should be surgically treated because of the possibility of rupture [12]. Particularly risky groups of patients are pregnant women, patients with portal hypertension, and patients in whom liver transplantation is planned [2,12].…”

“…Some authors consider that all symptomatic patients, as well as patients with no symptoms, whose SAA is > 20 mm in diameter, should be surgically treated because of the possibility of rupture [12]. Particularly risky groups of patients are pregnant women, patients with portal hypertension, and patients in whom liver transplantation is planned [2,12]. In patients without symptoms, in whom SAA is < 20 mm in diameter, radiological follow-up by abdominal CT every six months should be enough [1,2,12].…”

Visceral Artery Aneurysms: Decision Making and Treatment Options in the New Era of Minimally Invasive and Endovascular Surgery

“…In their series of 11 patients with SAAs, Małczak et al reported successful aneurysmectomy with spleen preservation in seven patients with one patient undergoing partial splenectomy and two patients receiving intraoperative splenectomies. 18 Distal SAAs and those intimately associated with the splenic parenchyma are treated by splenectomy and occasionally distal pancreatectomy may be required for an embedded aneurysm. 19 More recently, laparoscopic aneurysmectomy with or without spleen preservation has been reported with excellent results.…”