title: A modified laparoscopic splenectomy for massive splenomegaly in children with hematological disorder: a single institute retrospective clinical research.
abstract: OBJECTIVE
  With the optimal acceptance of its clinical advantages, laparoscopic splenectomy (LS) emerged as a gold standard procedure as compared with open splenectomy (OS). However, it is still controversial and even counted as contraindication for massive splenomegaly. Here, we aim to summarize the experiences, characteristics and trends of modified LS for massive splenomegaly in children with hematological disorders.
  
  
  METHODS
  Retrospective series of 57 pediatric patients with massive splenomegaly who underwent splenectomy from March 2007 to December 2011 were designated for this clinical analysis. The main outcome measures were dealt by statistics. For 30 cases of LS, we strictly adhered to the principle of using only three trocars to operate and initial ligation of the splenic artery, followed by retrieving the piecemeal of spleen through an accessory incision of 2-3 cm at 12 mm trocar port site.
  
  
  RESULTS
  Of the 57 pediatric patients, 27 underwent OS and 30 underwent LS, respectively. Despite the operative time being shorter for OS than for LS (P < 0.001), the blood loss was lower in LS than in OS (P < 0.001); the time required for oral intake as well as duration of hospital stay was lower in LS than in OS (P < 0.001). Post-operatively, 7 (25.9 %) complications occurred in OS and 3 (10 %) in LS. The conversion rate of LS to OS was 13.33 % in four cases till 2009.
  
  
  CONCLUSIONS
  Despite the conflicting reports regarding the safety of LS for massive splenomegaly, we demonstrated that our modified laparoscopic splenectomy in the treatment of children with massive splenomegaly in hematological diseases seemed to achieve the fundamental goal of less invasion; it was safe and feasible.
authors.affiliation: Department of Pediatric Surgery, The Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou 510120, The People's Republic of China. dengxiaogeng@yahoo.com.cn
authors.forename: Xiao-Geng
authors.initials: XG
authors.lastname: Deng
authors.forename: Anu
authors.initials: A
authors.lastname: Maharjan
authors.forename: Jing
authors.initials: J
authors.lastname: Tang
authors.forename: Rong-Lin
authors.initials: RL
authors.lastname: Qiu
authors.forename: Yao-Hao
authors.initials: YH
authors.lastname: Wu
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.forename: Jia-Jia
authors.initials: JJ
authors.lastname: Zhou
authors.forename: Le-Xiang
authors.initials: LX
authors.lastname: Zeng
authors.forename: Mei-Jin
authors.initials: MJ
authors.lastname: Chen
authors.forename: Yi-Qin
authors.initials: YQ
authors.lastname: Xiang
authors.forename: Jie-Min
authors.initials: JM
authors.lastname: Deng
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006402:Hematologic Diseases / Q000150:complications*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000209:etiology* / Q000601:surgery*