Institutional experience with laparoscopic partial splenectomy for hereditary spherocytosis.
OBJECTIVE
Moderate to severe hereditary spherocytosis (HS) is treated with splenectomy. However, total splenectomy leads to decreased immunologic function with the risk of overwhelming postsplenectomy sepsis. Splenic preservation is postulated as a method to avoid this potentially fatal complication. Although mainly performed through laparotomy, we report our experience with a laparoscopic approach to partial splenectomy for HS.


METHODS
A retrospective review was conducted on 9 laparoscopic partial splenectomies performed for HS at our institution. Follow-up was from 1 to 3.5 years. Data included preoperative and postoperative hemoglobin, absolute reticulocyte count, splenic size, operative time, complications, and length of stay.


RESULTS
All patients successfully underwent laparoscopic partial splenectomy with a radiologically determined upper-pole remnant of 10% to 30% and preservation of the blood supply through the upper short gastric arteries. The mean preoperative spleen length was 13 cm. Mean hospital stay was 3.6 days (range, 1-6 days). There was 1 intraoperative complication (a small bowel tear during spleen extraction) and 2 minor postoperative complications (ileus and wound infection). One patient underwent completion total splenectomy 2 years after partial splenectomy.


CONCLUSIONS
Laparoscopic partial splenectomy is a feasible and effective procedure that addresses the hematologic consequences of HS while retaining a portion of functional spleen, in addition to conferring the advantages of laparoscopy.
Slater
Bethany J
BJ
Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA 94305-5733, USA.
Chan
Frandics P
FP
Davis
Karen
K
Dutta
Sanjeev
S
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008137:Longitudinal Studies; D018810:Magnetic Resonance Angiography; D008297:Male; D009929:Organ Size; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011859:Radiography; D012189:Retrospective Studies; D013103:Spherocytosis, Hereditary / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013154:Spleen / Q000000981:diagnostic imaging / Q000473:pathology; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome