Abstract:

Purpose: to prove the safety and efficiency of minimally invasive endovascular and puncture techniques in management of splen diseases in children.

Aims: to develop standard procedures and justify the necessity of splenic artery embolization (SAE) in hemangiomas, extrahepatic portal hypertension, and idiopathic thrombocytopenic purpura (ITP). Develop standard procedures for splenic cysts treatment in pediatric practice.

Materials and methods: there were 129 children aged 3-16 years treated in Endovascular Surgery Department of Russian State Pediatric Hospital (Moscow) with the following diagnoses: hemangiomas (4 patients), hereditary hemolytic globular-cell anemia - HHGCA (41 cases), extrahepatic portal hypertension - EHPG (25 cases), ITP (24 cases), and nonparasitic cysts (35 patients).

Results: SAE is shown to be effective in treatment the diseases where splenic hyperfunctioning is seen. In HHGCA and ITP no hemolytic crises were seen, and there was no need of substitution therapy after performing the SAE procedure. In cases of EHPG splenic artery embolization is proved to reduce the esophageal varices and decrease hypersplenia symptoms. Among the advantages of endovascular approach can be named minimal operation trauma and splenic tissue preservation. The authors present an algorithm for splenic cysts treatment in pediatric practice. It was shown that laparoscopy is effective in big (over 70-80 mm) subcapsular cysts, whereas intraparenchymatous cysts fewer than 70 mm in diameter are more suitable for puncture techniques.

Conclusions: the minimally invasive techniques are shown to be safe and effective in management of splen diseases in pediatric practice. It was shown that their effectiveness is comparable to the conventional methods, meanwhile they cause much less operation trauma, reduce the hospital stay and terms of rehabilitation.

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