title: Splenectomy in childhood. The laparoscopic approach.
abstract: BACKGROUND
  We set out to analyze the results of the first 19 laparoscopic splenectomies performed by our team in order to show the advantages and limitations of the laparoscopic approach to this kind of procedure in children.
  
  
  METHODS
  Between March 1994 and June 1997, 19 children underwent laparoscopic splenectomy; two of them also had a concomitant cholecystectomy. Their ages ranged between 4 and 14 years (median, 7.2 years). There were 14 girls and 5 boys. All the patients underwent elective laparoscopic splenectomy: seven children had hereditary spherocytosis, six were affected by a beta thalassemia, five had an idiopathic thrombocytopenia purpura, and one presented with sickle cell disease.
  
  
  RESULTS
  Mean operating time was 145 min (range, 110-240 min). Hospital stay ranged from 2 to 5 days (median, 3 days). In three patients, the spleen was removed with a 7-cm mini-laparotomy, according to the technique of Pfannenstiell, in the suprapubic region. In the other 16 cases, the spleen was captured into a extraction bag, finger-fragmented, and removed from the umbilical orifice.
  
  
  CONCLUSIONS
  Laparoscopic splenectomy can be performed only when the spleen can be removed through the umbilical orifice with an extraction bag. For this reason, preoperative ultrasonography is necessary to measure the exact spleen volume. When the spleen is very large, an open splenectomy is preferable.
authors.affiliation: Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Esposito
authors.forename: F
authors.initials: F
authors.lastname: Corcione
authors.forename: G
authors.initials: G
authors.lastname: Ascione
authors.forename: V
authors.initials: V
authors.lastname: Garipoli
authors.forename: F
authors.initials: F
authors.lastname: Di Pietto
authors.forename: M
authors.initials: M
authors.lastname: De Pasquale
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011696:Purpura, Thrombocytopenic / Q000150:complications; D013103:Spherocytosis, Hereditary / Q000150:complications; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography; D017086:beta-Thalassemia / Q000150:complications