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[Organ preserving spleen surgery in childhood]
Insights
Organ-preserving spleen procedures are effective in children with traumatic rupture, with 75% of patients retaining their spleen. Spleen preservation is recommended whenever possible in pediatric cases.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Oncology
Background:
- Spleen preservation in pediatric patients is crucial for maintaining immune function.
- Traumatic spleen rupture and Hodgkin's disease are common indications for surgical intervention in children.
Observation:
- This study reviewed organ-saving procedures for spleen conditions in 12 children with traumatic rupture and 11 with Hodgkin's disease.
- Organ preservation was achieved in 75% of traumatic rupture cases through partial splenectomy, splenorrhaphy, fibrin adhesive repair, or conservative management.
- Spleen-preserving surgeries, including enucleation of cysts and splenopexy for wandering spleen, were performed in other pediatric cases.
Findings:
- Partial or complete spleen preservation was successful in 9 out of 12 children (75%) with traumatic rupture.
- In Hodgkin's disease cases, partial splenectomy was performed on five patients, with organ removal reserved for macroscopically involved spleens.
- Successful organ-saving procedures included partial splenectomy, splenorrhaphy, fibrin adhesive repair, conservative management, cyst enucleation, and splenopexy.
Implications:
- These findings support the feasibility and benefits of spleen-preserving strategies in pediatric surgery.
- Minimizing splenectomy in children can help prevent long-term complications such as overwhelming post-splenectomy infection.
- Spleen preservation should be prioritized in pediatric patients whenever clinically appropriate, balancing oncological or trauma management with immunological outcomes.
Abstract:
Our experiences with organ saving procedures of the spleen in childhood are presented. In 9 out of 12 children (75%) with traumatic rupture we preserved the organ partially or completely. In 4 patients a partial splenectomy was performed, in three cases of splenorrhaphy was done, and once the organ was repaired with fibrin adhesive. One child was treated conservatively. Another patient underwent splenectomy followed by autotransplantation. Two out of twelve died intra- or postoperatively from severe concomitant injuries. Out of 11 patients with Hodgkin's disease we performed partial splenectomy in five. Only in macroscopically involved cases the organ was removed. In one patient a huge epidermoid cyst of the spleen was enucleated. In another child with a big twisted wandering spleen a splenopexy after partial resection was carried out. In children the spleen should be preserved if ever possible.