Laparoscopic versus open splenectomy in children

Robert K. Minkes, Mara Lagzdins, Jacob C. Langer

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Background: The authors have reviewed their initial experience with laparoscopic splenectomy (LS) to identify the indications, success rate, and complications associated with this procedure compared with a series of children undergoing open splenectomy (OS) during the same time period. Methods: The records of 51 children who underwent splenectomy from 1993 through 1998 were reviewed retrospectively. Results: Thirty-five patients aged 1 to 17 years (mean, 9.4 years) underwent LS for the following indications: ITP (n = 20), sickle cell disease or thalassemia (n = 6), hereditary spherocytosis (n = 5), other hematologic disorders (n = 4). Seventeen patients aged 2 to 17 years (mean, 11.8 years) underwent OS during the same time period for ITP (n = 4), sickle cell disease or thalassemia (n = 4), hereditary spherocytosis (n = 5), and other indications (n = 4). Concomitant cholecystectomy was performed in 4 of 35 LS and 4 of 17 OS. Accessory spleens were identified in 10 of 35 LS and 2 of 17 OS cases. Eleven spleens were enlarged in the LS group, and 8 were enlarged in the OS group. One LS required conversion to an open procedure because the spleen did not fit in the bag. No other cases were converted. Median estimated blood loss was 50 mL for both the LS and OS groups. The only intraoperative complication in the LS group was a splenic capsular tear, which had no effect on the successful laparoscopic removal of the spleen. No patient in either group required a blood transfusion. The LS patients had a shorter length of hospital stay (1.8 ± 1 versus 4.0 ± 1 day, P = .0001). Total hospital charges were not significantly different. Follow-up ranged from 6 to 40 months. One LS patient died 47 days postoperatively from unrelated causes. Two LS patients had recurrent ITP; accessory spleens were found in one and resected laparoscopically. Conclusion: LS in children can be performed safely with a low conversion rate (2.9%) and is associated with a shorter hospital stay and comparable total hospital cost when compared with OS. Copyright (C) 2000 by W.B. Saunders Company.

Original languageEnglish (US)
Pages (from-to)699-701
Number of pages3
JournalJournal of Pediatric Surgery
Volume35
Issue number5
StatePublished - May 2000

Fingerprint

Splenectomy
Inosine Triphosphate
Spleen
Length of Stay
Thalassemia
Sickle Cell Anemia
Conversion to Open Surgery
Hospital Charges
Hospital Costs
Splenomegaly
Intraoperative Complications
Cholecystectomy

Keywords

  • Childhood splenectomy
  • Laparoscopic splenectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Minkes, R. K., Lagzdins, M., & Langer, J. C. (2000). Laparoscopic versus open splenectomy in children. Journal of Pediatric Surgery, 35(5), 699-701.

Laparoscopic versus open splenectomy in children. / Minkes, Robert K.; Lagzdins, Mara; Langer, Jacob C.

In: Journal of Pediatric Surgery, Vol. 35, No. 5, 05.2000, p. 699-701.

Research output: Contribution to journalArticle

Minkes, RK, Lagzdins, M & Langer, JC 2000, 'Laparoscopic versus open splenectomy in children', Journal of Pediatric Surgery, vol. 35, no. 5, pp. 699-701.
Minkes, Robert K. ; Lagzdins, Mara ; Langer, Jacob C. / Laparoscopic versus open splenectomy in children. In: Journal of Pediatric Surgery. 2000 ; Vol. 35, No. 5. pp. 699-701.
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AB - Background: The authors have reviewed their initial experience with laparoscopic splenectomy (LS) to identify the indications, success rate, and complications associated with this procedure compared with a series of children undergoing open splenectomy (OS) during the same time period. Methods: The records of 51 children who underwent splenectomy from 1993 through 1998 were reviewed retrospectively. Results: Thirty-five patients aged 1 to 17 years (mean, 9.4 years) underwent LS for the following indications: ITP (n = 20), sickle cell disease or thalassemia (n = 6), hereditary spherocytosis (n = 5), other hematologic disorders (n = 4). Seventeen patients aged 2 to 17 years (mean, 11.8 years) underwent OS during the same time period for ITP (n = 4), sickle cell disease or thalassemia (n = 4), hereditary spherocytosis (n = 5), and other indications (n = 4). Concomitant cholecystectomy was performed in 4 of 35 LS and 4 of 17 OS. Accessory spleens were identified in 10 of 35 LS and 2 of 17 OS cases. Eleven spleens were enlarged in the LS group, and 8 were enlarged in the OS group. One LS required conversion to an open procedure because the spleen did not fit in the bag. No other cases were converted. Median estimated blood loss was 50 mL for both the LS and OS groups. The only intraoperative complication in the LS group was a splenic capsular tear, which had no effect on the successful laparoscopic removal of the spleen. No patient in either group required a blood transfusion. The LS patients had a shorter length of hospital stay (1.8 ± 1 versus 4.0 ± 1 day, P = .0001). Total hospital charges were not significantly different. Follow-up ranged from 6 to 40 months. One LS patient died 47 days postoperatively from unrelated causes. Two LS patients had recurrent ITP; accessory spleens were found in one and resected laparoscopically. Conclusion: LS in children can be performed safely with a low conversion rate (2.9%) and is associated with a shorter hospital stay and comparable total hospital cost when compared with OS. Copyright (C) 2000 by W.B. Saunders Company.

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