Massive Splenomegaly in Children: Laparoscopic Versus Open Splenectomy

Abstract

Background and Objectives:Laparoscopic splenectomy for massive splenomegaly is still a controversial procedure as compared with open splenectomy. We aimed to compare the feasibility of laparoscopic splenectomy versus open splenectomy for massive splenomegaly from different surgical aspects in children.Methods:The data of children aged <12 years with massive splenomegaly who underwent splenectomy for hematologic disorders were retrospectively reviewed in 2 pediatric surgery centers from June 2004 until July 2012.Results:The study included 32 patients, 12 who underwent laparoscopic splenectomy versus 20 who underwent open splenectomy. The mean ages were 8.5 years and 8 years in the laparoscopic splenectomy group and open splenectomy group, respectively. The mean operative time was 180 minutes for laparoscopic splenectomy and 120 minutes for open splenectomy. The conversion rate was 8%. The mean amount of intraoperative blood loss was 60 mL in the laparoscopic splenectomy group versus 110 mL in the open splenectomy group. Postoperative atelectasis developed in 2 cases in the open splenectomy group (10%) and 1 case in the laparoscopic splenectomy group (8%). Oral feeding postoperatively resumed at a mean of 7.5 hours in the laparoscopic splenectomy group versus 30 hours in the open splenectomy group. The mean hospital stay was 36 hours in the laparoscopic splenectomy group versus 96 hours in the open splenectomy group. Postoperative pain was less in the laparoscopic splenectomy group.Conclusion:Laparoscopic splenectomy for massive splenomegaly in children is safe and feasible. Although the operative time was significantly greater in the laparoscopic splenectomy group, laparoscopic splenectomy was associated with statistically significantly less pain, less blood loss, better recovery, and shorter hospital stay. Laparoscopic splenectomy for pediatric hematologic disorders should be the gold-standard approach regardless of the size of the spleen.

Laparoscopic splenectomy in pediatric age

“…(18) Karadag ve ark. 'da (19) yaptıkları çalışmalar sonucunda, laparoskopik splenektominin büyük dalaklarda güvenli ve efektif bir işlem olduğu-nu ispatlamışlardır.…”

Elektif olgularda açık ve laparaskopik splenektominin karşılaştırılması

“…Masif splenomegali laparoskopik cerrahi yapılmaya başlandığı ilk zamanlarda LS için kontrendike olarak kabul edilmekte idi. Cerrahi deneyimin artması ile son yıllarda LS, dalak boyutuna bakılmaksızın güvenli bir cerrahi olarak uygulanmaktadır [15][16][17] .…”

Open vs Laparoscopic Splenectomy among Saudi Patients

“…Even in the setting of massive splenomegaly, there is some indication to recommend that the laparoscopic method is safe and feasible in children [4] . With the advent of minimally invasive techniques, laparoscopic splenectomy has become a standard procedure for elective removal of the spleen for most indications.…”