A comparison of laparoscopic versus open splenectomy in children

Laparoscopic operative procedures are gaining wider acceptance in pediatric patients. Although laparoscopic splenectomy is being performed more frequently, no studies to date have compared this procedure with the standard open technique with respect to operative outcomes. We performed a case control study of seven laparoscopic splenectomies and 14 open splenectomies. Two-tailed t test was used to compare the two groups for mean operative time, mean hospital stay, mean interval before tolerating a regular diet, and total parenteral narcotic dose in morphine equivalents. Operative time was significantly longer in the laparoscopic group (221 minutes vs 59 minutes, P < 0.001). Hospital stay, interval before tolerating a regular diet, and postoperative narcotic dose did not differ significantly between the two groups. In the laparoscopic group, one operation was converted to an open procedure secondary to bleeding complications. Three patients required mini-laparotomies for removal of extremely large spleens after completion of the dissection. Pediatric laparoscopic splenectomy does not appear to have advantages over the traditional method with regard to operative time, hospital stay, postoperative ileus, or postoperative pain. Larger studies, including cost analysis, are needed before major proposed advantages of laparoscopic splenectomy can be accepted.