En-bloc stapling of the splenic hilum in laparoscopic splenectomy

Vascular staplers or clips for sectioning of the splenic artery and vein are the procedure of choice in laparoscopic surgery. There are some concerns about the possible complications such as pancreatic injury, arteriovenous fistula (AVF) formation and portal or splenic vein thrombosis related to stapler usage. Hence this study was aimed to evaluate the safety and advisability of en-bloc mass stapling of the splenic hilum. A retrospective chart review was performed of 17 consecutive children undergoing laparoscopic splenectomy between June 2003 and June 2005 by a single surgeon. A routine four-trocar technique was used in all patients. Vascular isolation was achieved with an Endo-GIA (powered vascular linear stapler) without individual dissection of the splenic artery and vein. Doppler ultrasonographic evaluation was performed in order to search for a possible portal or splenic vein thrombosis and arteriovenous fistula formation in all patients one year after the operation. En-bloc stapling of the hilum was successfully performed in all children. No immediate or short-term complications related to en bloc stapling were observed. There were no arteriovenous fistula formations and splenic or portal vein thrombosis related to the previous operation with a mean follow-up of 21 months (12-36 months). En-bloc stapling can thus be safely performed in pediatric laparoscopic splenectomy with no related short-term vascular complications.