A Comparison of Single-Incision Versus Multiport Laparoscopic Splenectomy in Children

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Surgical Outcomes

Background:

• Single-incision endoscopic splenectomy (SIES-Sp) is a minimally invasive technique with demonstrated feasibility and safety.
• Limited comparative data exists between SIES-Sp and multiport laparoscopic splenectomy (MPLS), particularly in pediatric populations.
• Understanding comparative outcomes is crucial for optimizing surgical approaches in children.

Purpose of the Study:

• To compare the safety and efficacy of SIES-Sp versus MPLS in children undergoing total splenectomy.
• To evaluate complication rates, operative time, hospital stay, and postoperative pain.
• To assess the impact of additional procedures on the choice of splenectomy technique.

Main Methods:

• Retrospective review of pediatric patients (<18 years) undergoing total splenectomy between 2000 and 2019.
• Comparison of SIES-Sp (n=29) and MPLS (n=19) groups using univariate analysis.
• Primary outcome: 30-day complication rate (Clavien-Dindo score); Secondary outcomes: conversion, operative time, length of stay, pain, readmission.

Main Results:

• No significant differences in complication rates (7% SIES-Sp vs. 11% MPLS) or readmission/reoperation rates between the two groups.
• SIES-Sp patients had smaller spleens (dimension and weight) compared to MPLS patients (P < .05).
• Severe complications were rare, including cardiac arrest (SIES-Sp) and bleeding requiring reoperation (MPLS).

Conclusions:

• SIES-Sp is a safe and viable alternative to MPLS for pediatric total splenectomy.
• The presence of additional procedures does not necessarily preclude the use of SIES-Sp.
• Larger spleen size may pose a challenge for the SIES-Sp approach, warranting careful consideration.