Outcomes Following Sclerotherapy or Surgical Resection as Initial Management for Non-parasitic Splenic Cysts in Children

Background: The optimal management of splenic cysts in children remains undefined given the multiple treatment modalities available. Laparoscopic surgery with splenic preservation may seem favored, but is limited by clinically significant rates of cyst recurrence. Sclerotherapy is a less invasive treatment with very little outcome data available. Sclerotherapy can also complicate surgical resection by creating scarring in the operative field. The present study examines the safety and preliminary efficacy of sclerotherapy for splenic cysts in children and compares those outcomes to laparoscopic treatment via cyst excision or marsupialization.

Methods: A retrospective review of pediatric patients treated for nonparasitic splenic cysts between 2007 and 2021 at a single institution was performed. Included patients had International Classification of Disease, Tenth Revision, Clinical Modification diagnosis code D73.4 or D73.89 and underwent either, observation, sclerotherapy or a splenic operation (cyst excision or marsupialization). Pre and post treatment demographics, imaging and symptomatology were reviewed. Cyst size was recorded using the maximum diameter and volume on imaging pre and post procedure.

Results: 30 patients met inclusion criteria with ages ranging from 0-18 years at the time of diagnosis. 8 patients underwent surgical excision while 8 underwent sclerotherapy and 14 were observed. 3/8 sclerotherapy patients were either unresolved or recurred, requiring surgical management. All sclerotherapy patients who required eventual surgical management had a maximum cyst diameter of >8 cm on presentation. 5/8 sclerotherapy patients had resolution of symptoms and had significantly reduced cyst volume post sclerotherapy (61.4% vs 7.0%, p<0.05). No patients in the surgery group had evidence of recurrence on follow up imaging or clinical exam.

Conclusion: Sclerotherapy is a potentially effective treatment for splenic cysts, particularly those measuring less than 8cm in largest diameter; however, for larger cysts, laparoscopic treatment may offer a lower recurrence rate. A prospective comparison of sclerotherapy vs. surgical treatment is needed to determine the optimal application of either modality in the treatment of splenic cysts in children.