Primitive isolated hydatid cyst of the spleen: total splenectomy versus spleen saving surgical modalities

Abstract

Background This study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease. Methods This is a descriptive retrospective study carried out over a period of 7 years extending from January 2013 to December 2019 reporting eight cases of isolated primitive splenic hydatid cysts. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy. Results The diagnosis was incidentally made in 50% of cases. The main other revealing complaints are pain in the left upper quadrant of abdomen in 25% of cases and a painless renitent mass in the same quadrant in only 12,5%. None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay (9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. Conclusions The current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures. It seems to be the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.

A 16-year-old adolescent with a history of minor abdominal trauma diagnosed with a giant isolated primary splenic hydatid cyst: a case report

“…This method ensures a decreased hospital stay, reduced healthcare costs, and a lower likelihood of recurrence. Patients undergoing spleen-preserving surgery tend to experience a longer average hospital stay, primarily attributable to postoperative complications such as abscess formation in the residual cavity and postoperative haemorrhage when compared to those who undergo total splenectomy 18 . Furthermore, there is no statistically significant difference in recurrence rates observed between splenectomy and spleen-sparing surgery 19 .…”

Hydatid Disease: A Radiological Pictorial Review of a Great Neoplasms Mimicker

“…The main diagnostic problem is that it can mimic other splenic cystic lesions, such as epidermoid and dermoid cysts, solitary abscesses, hematomas, cystic hemangiomas, intrasplenic pancreatic pseudocysts, and lymphangiomas [ 33 ]. A total splenectomy is the treatment of choice for splenic hydatid cysts [ 31 , 34 ]. Figure 10 and Figure 22 .…”