Laparoscopic splenic procedures in children: experience in 231 children.
OBJECTIVE
The purpose of this report is to evaluate the efficacy of and complications observed after laparoscopic splenic procedures in children.


METHODS
Review of a prospective database at a single institution (1995-2006) identified 231 children (129 boys; 102 girls; average age 7.69 years) undergoing laparoscopic splenic procedures.


RESULTS
Two hundred twenty-three children underwent laparoscopic splenectomy (211 total; 12 partial) by the lateral approach. Indication for splenectomy was hereditary spherocytosis (111), immune thrombocytopenic purpura (36), sickle cell disease (SCD) (51), and other (25). Four (2%) required conversion to an open procedure. Eight additional laparoscopic splenic procedures were performed: splenic cystectomy for epithelial (4) or traumatic (2) cyst, and splenopexy for wandering spleen (2). Average length of stay was 1.5 days. Complications (11% overall, 22% in SCD patients) included ileus (5), bleeding (4), acute chest syndrome (5), pneumonia (2), portal vein thrombosis (1), priapism (1), hemolytic uremic syndrome (1), diaphragm perforation (2), colonic injury (1), missed accessory spleen (1), trocar site hernia (1), subsequent total splenectomy after an initial partial (1), and recurrent cyst (1). Subsequent operations were open in 3 (colon repair, hernia, and missed accessory spleen) and laparoscopic in 2 (completion splenectomy, and cyst excision). There were no deaths, wound infections, or instances of pancreatitis.


CONCLUSIONS
Laparoscopic splenic procedures are safe and effective in children and are associated with low morbidity, higher complication rate in SCD, low conversion rate, zero mortality, and short length of stay. Laparoscopic splenectomy has become the procedure of choice for most children requiring a splenic procedure.
Rescorla
Frederick J
FJ
Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA. frescorl@iupui.edu
West
Karen W
KW
Engum
Scott A
SA
Grosfeld
Jay L
JL
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000601:surgery; D002637:Chest Pain / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003560:Cysts / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D045823:Ileus / Q000209:etiology; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013103:Spherocytosis, Hereditary / Q000601:surgery; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000601:surgery; D016896:Treatment Outcome; D050805:Wandering Spleen / Q000601:surgery