Laparoscopic resection of splenic artery aneurysms

Acta Chirurgica Belgica, 2018

The first laparoscopic treatment of splenic artery aneurysm (SAA) was performed in 1993. Since then, many papers have been published mentioning different laparoscopic treatment modalities, including splenectomy, aneurysmectomy, ligation or even occlusion. Patients and methods: An updated literature review of the English medical literature using the following MeSH, 'Lapaorscopic splenic artery aneurysm', 'laparoscopic aneurysectomy', 'Laparoscopic Splenic artery Aneurysm Ligation' and 'Laparoscopic Splenic artery aneurysm excision' was done. Also three cases performed at our institutions are discussed, in terms of techniques, morbidity, mortality and postoperative outcomes. Results: About eight case series and 16 case reports were retrieved from the literature. Different techniques were described by the authors, including splenectomy, aneurysmectomy, splenic aneurysm ligation or even occlusion. Few morbidity cases were reported and none of the authors has mentioned a single mortality case. In our three cases, the postoperative course was uneventful, with good long-term results. Conclusions: Despite the variations in the adopted operative techniques, the laparoscopic approach seems to be harmless. However, no treatment algorithm or consensus has been published.

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2009

Splenic artery aneurysm, although rare, is the commonest visceral aneurysm. Its management options have expanded with advances in minimally invasive techniques. In the last decade, the laparoscopic technique has gained popularity owing to its simplicity, safety, and short postoperative course in the experienced hand. We recommend the laparoscopic approach to be considered as the first option in the management of splenic artery aneurysm. It is of particular use in pregnant women where this condition has a high mortality and morbidity.

Surgical Endoscopy, 2012

Background The literature does not support the choice between open and laparoscopic management of splenic artery aneurysms (SAA). Methods We designed a prospective, randomized comparison between open and laparoscopic surgery for SAA. Primary end points were types of surgical procedures performed and clinical outcomes. Analysis was developed on an intention-to-treat basis. Results Fourteen patients were allocated to laparotomy (group A) and 15 to laparoscopy (group B). Groups displayed similar patient-and aneurysm-related characteristics. The conversion rate to open surgery was 13.3 %. The type of surgical procedure performed on the splenic artery was similar in the two groups: aneurysmectomy with splenic artery ligature or direct anastomosis was performed in 51 % and 21 % of patients in group A and in 60 % and 20 % in group B, respectively. The splenectomy rate was similar (14 % vs. 20 %). Postoperative splenic infarction was observed in one case in each group. Laparoscopy was associated with shorter procedures (p = 0.0003) and lower morbidity (25 % vs. 64 %, p = 0.045). Major morbidity requiring interventional procedures and blood transfusion was observed only in group A. Laparoscopy was associated with quicker resumption of oral diet (p \ 0.001), earlier drain removal (p = 0.046), and shorter hospital stay (p \ 0.01). During a mean follow-up of 50 months, two patients in group A required hospital readmission. In group B, two patients developed a late thrombosis of arterial anastomoses. Conclusions Our study demonstrates that laparoscopy permits multiple technical options, does not increase the splenectomy rate, and reduces postoperative complications. It confirms the supposed clinical benefits of laparoscopy when ablative procedures are required but laparoscopic anastomoses show poor long-term results.

JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2013

Splenic artery aneurysm is more frequently diagnosed today with the advancement and liberal use of imaging modalities. A symptomatic aneurysm, an aneurysm of any diameter in a pregnant woman or a woman of childbearing age, and an aneurysm Ͼ2 cm are all strong indications for surgery because of a significantly increased risk for splenic artery rupture.

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2009

patients with SAA underwent laparoscopic surgery. Among these patients, 4 had splenectomy alone and 2 had splenectomy with distal pancreatectomy. The mean size of the aneurysm was 3.1 cm (range: 2 to 4 cm).

Journal of Vascular Surgery, 2009

Objectives: The purpose of this study was to report a series of 16 consecutive patients who underwent laparoscopic treatment of splenic artery aneurysms. Methods: Over a period of 8 years, patients were selected for the laparoscopic option by a team of specialists that included the vascular surgeon, the interventional radiologist, and the laparoscopic surgeon. The mean size of the aneurysm was 32 mm and most was located at the splenic hilum. They were twice as common in females as in males. Ultrasonography with color Doppler function was used to define intraoperative strategy. Results: The laparoscopic treatment entailed excision of the aneurysm or its exclusion, usually reserved for distally located lesions. In one patient, laparoscopic resection and robotic anastomosis of the splenic artery was performed to re-establish flow to the spleen. In two patients, the intraoperative decision was added to combine a laparoscopic splenectomy due to insufficient residual arterial flow to the spleen. There was no conversion, or need for re-operation or related mortality. Analysis of intraoperative arterial flow data avoided unnecessary splenectomy following noncritical reduction of flow to the spleen. Conclusions: The use of intraoperative color Doppler ultrasonography is essential in deciding the appropriate procedure and whether the spleen should be removed or saved. Early control of the splenic artery proximal to the aneurysm can limit the risk of conversion due to intraoperative bleeding. Distally located aneurysms are more difficult to manage and entail a higher risk of associated splenectomy. The laparoscopic option offers some advantages over the endovascular treatment in selected patients. A multidisciplinary approach is the key to a successful treatment of this uncommon disease. ( J Vasc Surg 2009;50:275-9.)

Srpski arhiv za celokupno lekarstvo

Introduction. Splenic artery aneurysm is the most common visceral aneurysm with a prevalence of 0.2?10%. It is the third most frequent abdominal aneurysm as well. It can be true or false. It occurs more often in women than in men. We present our experience with a 34-year-old female patient who underwent laparoscopic splenectomy due to the splenic aneurysm located in the splenic hilum. Case outline. We present a case of a 34-year-old female patient diagnosed with an enlarged splenic artery during a routine abdominal ultrasound examination. Abdominal scan and computed tomography angiography showed saccular aneurysm of the splenic artery located in the hilum of the spleen, 24 ? 17 mm in size. Given the good general condition and age of the patient, we decided to perform laparoscopic splenectomy. The operation was performed without complications, which was also the case with the postoperative flow. The patient was discharged from the hospital on the third postoperative day. Conclusion. ...

Journal of Vascular Surgery, 1999

Purpose: Surgical therapy for splenic artery aneurysms (SAAs) has traditionally consisted of a laparotomy with resection of the aneurysm and possibly a splenectomy. Our early experience with the laparoscopic approach to treat SAAs is reported. Methods: A retrospective review of medical records was conducted on all patients who underwent laparoscopic resection of SAAs at the Cleveland Clinic Foundation from May 1996 to August 1997. Results: Four patients with SAAs, three women and one man, with an average age of 55 years (range, 37 to 63 years), underwent successful laparoscopic SAA repair. The average size of the aneurysm was 3.2 cm (range, 2.5 to 5.0 cm). Three patients underwent an aneurysm resection, whereas one patient underwent simple ligation. Intraoperative ultrasound scanning with Doppler was used in three cases as a means of localizing the aneurysm and identifying all feeding vessels; the complete cessation of flow within the aneurysm in the case in which the feeding vessels were simply ligated was also documented. The average intraoperative time was 150 minutes (range, 100 to 190 minutes). The mean estimated blood loss was 105 mL (range, 20 to 300 mL). There were no intraoperative complications. The average hospital stay was 2.2 days (range, 1 to 4 days). Conclusion: The laparoscopic approach to splenic artery aneurysm by aneurysmectomy or splenic artery ligation can be safe and effective. The laparoscopic approach affords a short hospital stay and an effective result. (J Vasc Surg 1999;30:184-8.)

Medicinski pregled, 2009

Sazetak -Aneurizma je po definiciji trajno lokalno prosirenje dijametra arterije za 50% od uobicajenog dijametra posmatrane arterije. Aneurizma slezinske. tj, splenicne arterije (a. splenica) naicesca je visceralna arterijska aneurizma. Klinicki je najcesce asimptornatska, ali istovrerneno potencijalno zivotno ugrozavajuca, sa incidencijorn ruptuiranja 2-10%; u tom slucaju stopa mortaliteta krece se 20-36%. Pacijentkinja stara 51 godinu primljcna je na Kliniku za vaskularnu i transplantaeionu hirurgiju u Novorri Sadu nakon detekeije vel ike aneurizrne a. splenicae prilikom ultrasonografskog pregleda abdomena nakon holecistektomije. Dodatnom dijagnostikom -kompjuterizovanorn tomografijom abdomena sa i. v kontrastom digitalnom suptrakcionom angiografijorn potvrdena je aneurizma a. splenicae precnika 5 em, te je nakon preoperativne pripreme i procene rizika. indikovano elektivno operativno hirursko lecenje. Primenjen je hirurski pristup prosirenom levom supkostalnom incizijom po Chevronu, a detaljna hirurska eksploracija sledi otvaranjem omentalne burze. Nakon verifikacije istanjenog zida aneurizme sledi aneurizmektomija i rekonstrukcija a. splenicae termino-terminalnom anastomozom. Intraoperativno uzete su biopsije jetre i aneurizmatske vrece. Patohistoloski nalaz potvrduje aterosklerotsku etiologiju aneurizme, a kako postoperativni tok protice uredno, bolesniea se otpusta na dalje kucno lecenje osmi postoperativni dan. Kljucne reei: Aneurizma: Slezinska arterija; Dijagnoza: Elektivne hirurske procedure: Zen ski pol: Srednjc god inc Summary -An aneurysm has been defined as a permanent local dilatation ofthe diameter ofan artery by at least 5()% of its normal value. A splenic artery aneurysm is most frequently a visceral artery aneurysm and clinically it is usually asymptomatic but potentially life-threatening at the same time. with the incidence of its rupturing being 2-1()% and then the mortality rate rangesfrom 2() to 36%. A 5 J-year-old female patient was admitted to the Department of Vascular and Transplantation Surgery in Novi Sad having been found to have a big splenic artery aneurysm during the ultrasound examination of her abdomen after cholecystectomy. The additional diagnostic procedure -computerized tomography of the abdomen with i. v contrast subtraction angiography -confirmed the splenic artery aneurysm to have the diameter of5 em and therefore the elective surgical treatment was indicated after the preoperative preparation and risk assessment. The aneurysm was exposed through Chevron incision, and the detailed surgical exploration was done after the omental bursa had been opened. The aneurysmectomy and the reconstruction of the splenic artery by the termino-terminal anastomosis were performed after the weakening of the wall had been verified. The biopsies of the liver and the aneurysmal sac were done during the surgery. The pathohistologicalfinding confirmed the atherosclerotic etiology ofthe aneurysm. Since the postoperative course was normal, the patient 1vaS discharged on the eighth postoperative day.

Annals of medicine and surgery, 2020

BackgroundSpleen artery aneurysm represents the most common visceral aneurysm and the third most common splanchnic aneurysm. Most patients have no symptoms and are diagnosed as a part of other diagnostic focuses and examinations. Greater prevalence and application of modern diagnostic and imaging procedures has resulted in greater detection of this disease.ResultsWe present two patients with splenic artery aneurysms localized in the splenic hilum, who auspiciously underwent laparoscopic splenectomies with the use of hem-o-lock clips in the vascular hilum without complications. Both postoperative courses were uneventful. At six months follow up, both patients are asymptomatic.ConclusionThese two cases showed that in addition to the numerous advantages of minimally invasive approaches for treating splenic arterial aneurysms, there is a possibility to improve laparoscopic technique in terms of safety and economic reasons by using hem - o - lock clips as a hemostatic technique for the vascular elements of the spleen hilum.