Outcomes after early splenectomy for hematological disorders

Acute splenic sequestration crisis is a devastating complication of sickle cell disease that can require prophylactic splenectomy. Historically, splenectomy before 5 years of age was avoided because of fear of overwhelming postsplenectomy sepsis. Recently, splenectomy has been performed as early as 2 years of age, but the safety of this approach is unknown. This study compared outcomes of splenectomy performed in patients under 5 years of age with those 5 years of age and older.

A retrospective chart review of patients registered in a children's hospital hematology database was performed to examine intraoperative and postoperative outcomes after splenectomy. Statistical data analysis included Fisher's exact tests for categorical variables and the nonparametric median test for continuous variables.

From 1997 to 2012, 30 sickle cell patients underwent splenectomy. At surgery, 18 of the 30 patients were under 5 years of age (Group 1), and 12 patients were 5 years of age or older (Group 2). Almost all procedures were laparoscopic. Both group had similar operative times, rates of conversion, and frequencies of complications. Both groups had similar lengths of follow-up (median, 62 months for Group 1 versus 63 months for Group 2). No portal vein thromboses or postsplenectomy sepsis events occurred in either group.

In this study, there was no evidence that the incidence of complications was higher after splenectomy at a younger age. A large, multicenter study is needed to further evaluate the safety of this practice.