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Laparoscopic versus open splenectomy in children
R K Minkes1, M Lagzdins, J C Langer
1Department of Surgery, St. Louis Children's Hospital and Washington University School of Medicine, MO, USA.
Insights
Laparoscopic splenectomy (LS) in children is a safe procedure with a low conversion rate, offering a shorter hospital stay than open splenectomy (OS) with similar costs.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Review of initial experience with laparoscopic splenectomy (LS) in children.
- Comparison of LS with open splenectomy (OS) regarding indications, success rates, and complications.
Purpose of the Study:
- To evaluate the safety and efficacy of LS in pediatric patients.
- To compare outcomes of LS versus OS in children.
Main Methods:
- Retrospective review of 51 children who underwent splenectomy between 1993 and 1998.
- Analysis of indications, operative details, complications, hospital stay, and costs for both LS and OS groups.
Main Results:
- LS was performed in 35 children for various hematologic disorders; OS in 17.
- Median blood loss was similar (50 mL) for both groups; no transfusions were required.
- LS patients had a significantly shorter hospital stay (1.8 days vs. 4.0 days, P = .0001) with comparable total hospital charges.
Conclusions:
- Laparoscopic splenectomy (LS) is a safe and effective procedure for children.
- LS is associated with a low conversion rate (2.9%) and reduced hospital stay compared to open splenectomy (OS).
- The total hospital cost for LS is comparable to OS.
Background:
The authors have reviewed their initial experience with laparoscopic splenectomy (LS) to identify the indications, success rate, and complications associated with this procedure compared with a series of children undergoing open splenectomy (OS) during the same time period.
Methods:
The records of 51 children who underwent splenectomy from 1993 through 1998 were reviewed retrospectively.
Results:
Thirty-five patients aged 1 to 17 years (mean, 9.4 years) underwent LS for the following indications: ITP (n = 20), sickle cell disease or thalassemia (n = 6), hereditary spherocytosis (n = 5), other hematologic disorders (n = 4). Seventeen patients aged 2 to 17 years (mean, 11.8 years) underwent OS during the same time period for ITP (n = 4), sickle cell disease or thalassemia (n = 4), hereditary spherocytosis (n = 5), and other indications (n = 4). Concomitant cholecystectomy was performed in 4 of 35 LS and 4 of 17 OS. Accessory spleens were identified in 10 of 35 LS and 2 of 17 OS cases. Eleven spleens were enlarged in the LS group, and 8 were enlarged in the OS group. One LS required conversion to an open procedure because the spleen did not fit in the bag. No other cases were converted. Median estimated blood loss was 50 mL for both the LS and OS groups. The only intraoperative complication in the LS group was a splenic capsular tear, which had no effect on the successful laparoscopic removal of the spleen. No patient in either group required a blood transfusion. The LS patients had a shorter length of hospital stay (1.8 +/- 1 versus 4.0 +/- 1 day, P = .0001). Total hospital charges were not significantly different. Follow-up ranged from 6 to 40 months. One LS patient died 47 days postoperatively from unrelated causes. Two LS patients had recurrent ITP; accessory spleens were found in one and resected laparoscopically.
Conclusion:
LS in children can be performed safely with a low conversion rate (2.9%) and is associated with a shorter hospital stay and comparable total hospital cost when compared with OS.