Laparoscopic versus open pediatric splenectomy for massive splenomegaly

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Laparoscopic splenectomy (LS) offers advantages over open splenectomy (OS).
• Massive splenomegaly presents technical challenges for LS.
• Previous studies indicated LS failure in adults and children with massive splenomegaly.

Purpose of the Study:

• To evaluate the feasibility, safety, and efficacy of laparoscopic pediatric splenectomy for massive splenomegaly.
• To compare perioperative outcomes of LS versus OS in pediatric patients with massive splenomegaly.

Main Methods:

• Retrospective review of pediatric splenectomies (laparoscopic and open) for massive splenomegaly from April 1997 to October 2009.
• Defined massive splenomegaly by splenic margin location.
• Compared operative time, bleeding, spleen size, complications, and hospital stay between LS and OS groups.

Main Results:

• No deaths, wound infections, or pancreatitis occurred in either group.
• Laparoscopic splenectomy had a significantly lower complication rate (13.6%) compared to open splenectomy (41.2%).
• No accessory spleens were missed with LS, while 2 were missed with OS.

Conclusions:

• Laparoscopic pediatric splenectomy for massive splenomegaly is feasible, effective, and safe.
• LS is associated with low morbidity and short hospital stays.
• The minimally invasive approach is a viable alternative to open surgery for pediatric massive splenomegaly.