Laparoscopic splenectomy in adults and children: experience with 31 patients.
BACKGROUND
Open surgery is the standard approach for splenectomy in hematologic disorders, but a few cases of successful laparoscopic splenectomy have been reported.


METHODS
Thirty-one patients (18 adults, group 1; and 13 children, group 2) underwent laparoscopic splenectomy. Indications for surgery included idiopathic thrombocytopenic purpura (25 patients), congenital spherocytosis (4 patients), and hemolytic anemia (2 patients). In 97% of the patients the diameter of the spleen was less than 15 cm.


RESULTS
Laparoscopic splenectomy was successful in 94% of the patients; conversion to open surgery was mainly related to hemorrhage. Accessory spleen was found in 39% in group 1 and 8% in group 2. Two adults received intraoperative autotransfusion. Postoperative morbidity was minimal. The median postoperative stay was 3 days (range, 2 to 12 days) in group 1 and 2 days (range, 2 to 5 days) in group 2.


CONCLUSIONS
Laparoscopic splenectomy is safe in both adults and children. Adequate selection of patients (small-size spleen, splenic destruction on preoperative scanning of platelets), appropriate preparation in patients with idiopathic thrombocytopenic purpura (immunoglobulin G), and meticulous surgical technique (with routine opening of the gastrocolic ligament to search for accessory spleen) are key factors in obtaining the same long-term results as with open surgery.
Gigot
J F
JF
Department of Digestive Surgery, St-Luc University Hospital (Louvain Medical School), Brussels, Belgium
de Ville de Goyet
J
J
Van Beers
B E
BE
Reding
R
R
Etienne
J
J
Jadoul
P
P
Michaux
J L
JL
Ferrant
A
A
Cornu
G
G
Otte
J B
JB
Pringot
J
J
Kestens
P J
PJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013156:Splenectomy / Q000009:adverse effects; D014057:Tomography, X-Ray Computed