Laparoscopic Splenectomy Alone for Sickle Cell Disease: Account of 50 paediatric cases

Abstract

Objectives: In Oman, the most frequent indication for a splenectomy in children is sickle cell disease (SCD), which is one of the most common haematological disorders in the Gulf region. This study aimed to describe paediatric laparoscopic splenectomies alone for SCD at a tertiary hospital in Oman. Methods: This study was conducted between February 2010 and October 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all children aged ≤15 years old undergoing splenectomies during the study period were reviewed. Results: A total of 71 children underwent laparoscopic splenectomies during the study period; of these, 50 children (28 male and 22 female) underwent laparoscopic splenectomies alone for SCD. The children's weight ranged between 11-43 kg. The most common indication for a splenectomy was a recurrent splenic sequestration crisis (92%). Surgically removed spleens weighed between 155-1,200 g and measured between 9-22 cm. Operative times ranged between 66-204 minutes and intraoperative blood loss ranged between 10-800 mL. One patient required conversion to an open splenectomy. Postoperative complications were noted in only four patients. The median hospital stay duration was three days. Conclusion: Among this cohort, the mean operating time was comparable to that reported in the international literature. In addition, rates of conversion and postoperative complications were very low. These findings indicate that a laparoscopic splenectomy alone in paediatric patients with SCD is a feasible option.

Perioperative care of children with sickle cell disease: A systematic review and clinical recommendations

“…The systematic preoperative assessment of SCD patients varies considerably in its implementation and/or description. As expected, collecting a medical history and performing a physical examination is a standard recommendation . In particular, the documentation of a personal pain management history is part of some assessments, and aims to facilitate postoperative interventions and decision‐making in non‐opioid naïve patients .…”

“…Electrocardiogram and echocardiography are frequently performed. Abdominal ultrasonography to rule out cholelithiasis, and pulmonary function testing are suggested in several preoperative assessments. Investigations to identify infectious foci are consistently mentioned in the literature .…”

“…There are authors recommending prophylaxis according to type of surgery, and others adapting it to the individual patients' medical histories . As a standout, splenectomy needs specific considerations, including preoperative immunizations against encapsulated bacteria, as in the context of asplenia . Malaria prophylaxis is recommended by some authors, mostly in the older literature .…”

“…Regarding thresholds, earlier recommendations advocate “no transfusion” prior to surgery or minor risk surgeries, as long as the hemoglobin level was >4 to 5 g/dL . This limit had the tendency to move upwards with time, many authors currently recommending a hemoglobin level ≥9‐10 g/dL, before minor to intermediate risk surgery, whilst some groups still advocate 7 g/dL . A hemoglobin threshold of >10 g/dL is considered by some authors as a target for major surgeries .…”

“…Several studies address the aspects of surgical methodology specifically (prospective studies detailed in Table , all primary research in Table S3). Some authors recommend “open” approaches in retrospective studies but more recently, laparoscopy has been the standard . One group performed mini‐laparoscopy with low and stable‐pressure pneumoperitoneum with reduction of postoperative morbidity compared to standard laparoscopy …”