Laparoscopic splenectomy in children: experience in a single institution.
OBJECTIVE
To assess the safety and effectiveness of laparoscopic splenectomy in children.


METHODS
Hospital records of 63 patients who underwent laparoscopic splenectomy between 1998 and 2005 were reviewed retrospectively. In 16 patients concomitant cholecystectomy was performed. All procedures were performed by the same surgeon. The indications for splenectomy were hereditary spherocytosis (n = 35), idiopathic thrombocytopenic purpura (n = 22), autoimmune hemolytic anemia (n = 3), and other diseases (n = 3). Details of operative technique were reviewed and their implications on intraoperative complications are analyzed. The postoperative course and long-term results were assessed.


RESULTS
There were 35 girls and 28 boys, whose average age was 11.3 years (range, 3.9-19.5 years). There were 7 conversions, mainly at the beginning of the series. A mild degree of intraoperative bleeding was observed in 23 (36.5%) cases. In two cases (3%) severe bleeding led to conversion. Postoperatively, 1 patient required blood transfusion and 1 patient had signs of mild general infection that was treated conservatively. There was no mortality in this series. The mean operation time was 134 minutes for splenectomy and 174 minutes for splenectomy and cholecystectomy. Operative time did not significantly diminish at the end of the 7-year study period.


CONCLUSIONS
Laparoscopic splenectomy in children performed by an experienced team proved to be safe and effective with minimal side effects and should be recommended as a procedure of choice in children who require splenectomy.
Patkowski
Dariusz
D
Department of Paediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland. dpat@chdz.am.wroc.pl
Chrzan
Rafał
R
Wróbel
Grazyna
G
Sokół
Agnieszka
A
Dobaczewski
Grzegorz
G
Apoznański
Wojciech
W
Zaleska-Dorobisz
Urszula
U
Czernik
Jerzy
J
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006402:Hematologic Diseases / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000601:surgery*; D016896:Treatment Outcome