[Laparoscopic surgery of the spleen in children]

Laparoscopic operations of the spleen, incl. splenectomy, are increasingly accepted worldwide. The most frequent indications for this type of surgical treatment are haematological diseases (some types of haemolytic anaemia, thrombocytopenia, myeloproliferative syndrome). Another indication for surgery is hypersplenism from other causes such as vascular anomalies or isolated thrombosis of the lienal vein. The reason for urgent or planned laparoscopy may be also traumatic damage of the spleen (haemorrhage, pseudocysts). In the submitted work the authors present their experience with 21 patients where a laparoscopic operation of the spleen was performed. Of 21 children four were laparoscopically operated on account of a mesothelial cyst or posttraumatic pseudocyst of the spleen (ratio 1:3). In another 15 children laparoscopoc splenectomy was performed for haematological reasons (11 x spherocytosis, 3 x idiopathic thrombocytopenic purpura, 1 x autoimmune haemolytic anaemia). Twice the operation was indicated on account of isolated thrombosis of the lienal vein. In three instances a concurrently, also laparoscopic cholecystectomy was performed and in two liver biopsy. On operation 3-5 troacars were used and the patient was placed in a supine position. In no instance preoperative embolization of the lienal arteries was performed. On treatment of cystic structures of the spleen the authors made in three instances total resection of a cyst--in the upper pole of the spleen, in case of a central localization, only 2/3 resection and fixation of the omentum. In resections recently coagulation and Argon spraying was used. The spleen was extracted by morcellation in a plastic bag or via a 5 cm left-sided subcostal incision (2x). The median size of the spleen was 14.4 cm (10-20 cm), of cystic formations 7.25 cm (6-8 cm). The mean period of operation in splenectomy was 146 minutes. In two patients a blood transfusion was necessary (1x splenectomy, 1x resection of the lower third of the spleen). As to complications the authors recorded once major haemorrhage after splenectomy--resolved by the use of Endo GIA stapler. Conversion was not necessary in any of the operations. The mean period of hospitalization was 6 days.