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Splenectomy in childhood. The laparoscopic approach
C Esposito1, F Corcione, G Ascione
1Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
Surgical Endoscopy
|November 20, 1998
Summary
Laparoscopic splenectomy in children is feasible, with advantages in shorter hospital stays. However, spleen size is a limitation, necessitating preoperative ultrasonography to determine the best surgical approach.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic splenectomy is an evolving surgical technique for pediatric patients.
- Assessing the feasibility and outcomes of this approach is crucial for surgical decision-making.
Purpose of the Study:
- To evaluate the advantages and limitations of laparoscopic splenectomy in pediatric patients.
- To analyze the initial experience of a surgical team with this procedure.
Main Methods:
- A retrospective analysis of 19 pediatric patients who underwent laparoscopic splenectomy between March 1994 and June 1997.
- Patients' ages ranged from 4 to 14 years, with various hematological conditions including hereditary spherocytosis, beta-thalassemia, idiopathic thrombocytopenic purpura, and sickle cell disease.
Main Results:
- The mean operative time was 145 minutes, with a median hospital stay of 3 days.
- Spleen extraction involved a mini-laparotomy in 3 patients and fragmentation within an extraction bag via the umbilical orifice in 16 patients.
Conclusions:
- Laparoscopic splenectomy is viable when the spleen can be removed through the umbilical orifice using an extraction bag.
- Preoperative ultrasonography is essential to measure spleen volume and guide the decision between laparoscopic and open splenectomy, with open surgery preferred for very large spleens.