Evaluation of 39 pediatric cases who underwent open and laparoscopic splenectomy: A retrospective cohort study

Abstract

Aim: In children, aside from trauma-related splenic injury and splenic cysts, splenectomy is frequently performed in hematological diseases due to splenomegaly and thrombocytopenia. The most preferred method in children in the past years was open splenectomy. Today, laparoscopic splenectomy has become a preferred method by pediatric surgeons due to increasing laparoscopic surgical experience. The aim of this study is to present the results of the case series who underwent laparoscopic and open splenectomy in our clinic.
Methods: All patients who underwent laparoscopic and open splenectomy between 2008-2019 in our clinic were included in the study. Four ports were used in the laparoscopic splenectomy procedure and port locations differed according to patient age and spleen size. The completely liberated spleen was taken into the specimen removal bag and removed after morcellation. Open surgical method was preferred in cases where the long axis of the spleen was 200 mm or higher. Demographic data, splenectomy indications, surgical techniques and postoperative follow-up data were evaluated retrospectively.
Results: Splenectomy was performed laparoscopically in 24 of 39 patients (16 male, 23 female) and with the open method in 15 patients. Surgical indications included hereditary spherocytosis (n=15), idiopathic thrombocytopenic purpura (n=6), beta-thalassemia (n=3) in laparoscopically operated patients and hereditary spherocytosis (n=8), idiopathic thrombocytopenic purpura (n=4) and beta-thalassemia (n=3) in patients operated with the open method. Simultaneous cholecystectomy was performed in 11 cases due to cholelithiasis. The duration of the surgery was significantly longer [132 (47) and 90 (21) min., respectively P<0.001], and time until oral feeding [ 2.3 (0.8) and 3.9 (1.1) days, respectively P<0.001] as well as the length of hospitalization were significantly shorter in laparoscopic surgery compared to open surgery [3.80 (1.3) vs. 5.5 (1.2) days, respectively P<0.001].
Conclusion: Laparoscopic splenectomy is a safe method that should be preferred primarily in experienced centers for earlier feeding, shorter hospitalization times and better cosmetic results.