Pediatric laparoscopic splenectomy: benefits of the anterior approach.
BACKGROUND
Splenectomy is frequently performed in children for various hematologic and autoimmune disorders. We reviewed our indication for splenectomy, our technique of laparoscopic, splenectomy, and our results. The aim of this study was to show if an anterior approach with elective vessel endoligature in a patient in decubitus position was a better and safer approach than the other techniques previously published.


METHODS
Between January 1996 and December 2002, 54 children underwent laparoscopic splenectomy. We use the anterior pedicle approach and elective vessel endoligature in order to prevent persistence of any exogenous material. Sixteen children also had a concomitant cholecystectomy. Their age ranged between 1 and 18 years (mean 7.5 years). Twenty children had hereditary spherocytosis, 15 were affected by sickle cell disease, six had an idiopathic thrombocytopenia, four had beta-thalassemia, and nine another hemolytic disease.


RESULTS
Mean operative time was 150 min (range, 115-230 min). Hospital stays ranged from 3 to 15 days (mean: 5.4). Seven patients had complications (four pneumonia and three deep abscess with successful antibiotic treatment). Median follow-up was 42 months (2 months-6 years) without problems regarding procedure.


CONCLUSIONS
With this technique consisting in first elective arterial and secondary venal ligature, we preserved blood splenic sequestration and pancreatic tail lesion. The procedure is safer. For us, considering the low complication rate for this type of patient, and the advantages of a small abdominal trauma in the postoperative period, laparoscopy with anterior approach for elective splenectomy and eventual cholecystectomy in hematologic disorders is the best technique.
de Lagausie
P
P
Department of Pediatric Surgery, Hospital Robert Debré, Paris XIX, France. pascal.delagausie@rdb.aphop-paris.fr
Bonnard
A
A
Benkerrou
M
M
Rorlich
P
P
de Ribier
A
A
Aigrain
Y
Y
D018784:Abdominal Abscess / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000601:surgery; D001327:Autoimmune Diseases / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data; D005260:Female; D006402:Hematologic Diseases / Q000235:genetics / Q000276:immunology / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008026:Ligation; D008297:Male; D010297:Paris; D010996:Pleural Effusion / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012449:Safety; D013103:Spherocytosis, Hereditary / Q000601:surgery; D013156:Splenectomy / Q000379:methods* / Q000706:statistics & numerical data; D013789:Thalassemia / Q000601:surgery; D013921:Thrombocytopenia / Q000601:surgery; D016896:Treatment Outcome