Open Versus Laparoscopic Splenectomies in Children: A Comparative Study Performed at a Public Hospital in Brazil

In pediatric population, the two most common indications for splenectomy include traumatic rupture and hematological diseases such as hereditary spherocytosis, idiopathic thrombocytopenic purpura, sickle cell disease, and autoimmune hemolytic anemia. Traditionally, splenectomy has been an open procedure; however, since the first laparoscopic splenectomy was reported in 1991, the minimally invasive laparoscopic approach has become increasingly popular. In most public hospitals in Brazil, where vessel sealing devices are not available, most surgeons seem to prefer open splenectomy to guarantee intraoperative safety and improved outcomes. To compare outcomes between open and laparoscopic splenectomy in children in a public hospital in Brazil. Retrospective study conducted between January 2010 and June 2018. Patients from 0 to 14 years old who underwent open or laparoscopic splenectomy at the University Hospital of Federal University of Paraná were included. Clinical, laboratory, imaging, and surgical data were collected. For 8 years, 35 patients underwent splenectomy. Mean age was 4 years old and 54% were female. Of the 35 subjects, 69% had sickle cell anemia and 23% spherocytosis. The most common indication for surgery was a previous episode of splenic sequestration. The 13 laparoscopic surgeries were performed without harmonic scalpel or other vessel sealing devices. During the laparoscopic procedure, 2 patients experienced intraoperative complications: bleeding and prolonged surgical time due to technical problems with the equipment. Mean operative time was higher in laparoscopy group than in open group (186 minutes versus 66 minutes). Oral feeds began earlier on the laparoscopic group. Postoperatively, there were more complications on the open group, and no reoperations. There was only one fatality, likely secondary to fulminant sepsis, which occurred 34 days after the surgery in a patient who was undergoing prophylactic oral antibiotics therapy. Performing laparoscopic splenectomy without harmonic scalpel or other vessel sealing devices is feasible, but it implicates in a significantly higher surgical time. Laparoscopic splenectomy had earlier oral feeds and fewer complications than open surgery.