A K Meinke1, N R Floch, M P Dicorato. 1. Department of General Surgery, Norwalk Hospital, Norwalk, CT 06856, USA. Ameinke@pol.net
Abstract
BACKGROUND: The retrogastric and often intrapancreatic position of splenic artery aneurysms (SAA) has discouraged many surgeons from attempting the laparoscopic resection of SAA. Only two reports of successful laparoscopically resected SAA have appeared in the surgical literature. METHODS/ RESULTS: The successful laparoscopic resection of a large expanding SAA was accomplished using a modification of currently described techniques. CONCLUSIONS: The semilateral decubitus position affords excellent access to the lesser sac, allowing excision of SAA with good visualization of the splenic artery and splenic hilar vessels should splenic hypoperfusion demand splenic resection. Excision of SAA is preferred to ligation except when dense adhesions or intrapancreatic arterial course preclude safe dissection. Pseudoaneurysms from trauma or pancreatitis are likely best treated with intraarterial embolization but significant complications should be expected in this high-risk subset of patients.
BACKGROUND: The retrogastric and often intrapancreatic position of splenic artery aneurysms (SAA) has discouraged many surgeons from attempting the laparoscopic resection of SAA. Only two reports of successful laparoscopically resected SAA have appeared in the surgical literature. METHODS/ RESULTS: The successful laparoscopic resection of a large expanding SAA was accomplished using a modification of currently described techniques. CONCLUSIONS: The semilateral decubitus position affords excellent access to the lesser sac, allowing excision of SAA with good visualization of the splenic artery and splenic hilar vessels should splenic hypoperfusion demand splenic resection. Excision of SAA is preferred to ligation except when dense adhesions or intrapancreatic arterial course preclude safe dissection. Pseudoaneurysms from trauma or pancreatitis are likely best treated with intraarterial embolization but significant complications should be expected in this high-risk subset of patients.