title: Perioperative spleen embolization as a useful tool in laparoscopic splenectomy for simple and massive splenomegaly in children: a prospective study.
abstract: The purpose of this prospective study is to evaluate the efficiency of perioperative spleen embolization prior to laparoscopic splenectomy indicated for hypersplenism.
  
  
  
  We conducted a prospective study exploring a technique combining ultra-selective perioperative embolization and splenectomy. Between January 2008 and March 2013, 16 splenectomies were performed in children suffering from hypersplenism due to varying hematologic diseases. Spleen embolization was performed by an interventional radiologist in the operating room (OR) just before splenectomy and during the same general anesthesia. Ages varied from 3 to 17 years. Spleen volume was measured by preoperative ultrasound. One patient underwent a laparotomy because of suspected adhesions due to previous surgery. All other operations were performed laparoscopically.
  
  
  
  One complication arose from embolization: a perforation of the splenic artery. After immediately placing a platinum coil proximal to the perforation, the splenectomy was carried out as usual. Fourteen children (87.5 %) had splenomegaly, of which eight (50 %) had massive splenomegaly. There were no deaths, no conversions to laparotomy, no reoperations and none of these patients had to be transfused.
  
  
  
  Perioperative spleen embolization performed in the OR by an interventional radiologist makes laparoscopic splenectomy a safer procedure. We propose a preoperative method for spleen measurement that is adapted to children: simple and massive splenomegaly is defined through patient body weight and a preoperative ultrasound. We conclude that spleen size is no more a limiting factor for laparoscopic splenectomy in children.
authors.affiliation: Department of Pediatric Surgery, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, ULB, Brussels, Belgium. erwin@vdvk.be.
authors.forename: E
authors.identifier: 0000-0002-1226-1326
authors.initials: E
authors.lastname: Van Der Veken
authors.affiliation: Department of Radiology, CHU Brugmann, Université Libre de Bruxelles, ULB, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Laureys
authors.affiliation: Department of Pediatric Surgery, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, ULB, Brussels, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Rodesch
authors.affiliation: Department of Pediatric Surgery, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, ULB, Brussels, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Steyaert
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D013156:Splenectomy / Q000379:methods*; D013157:Splenic Artery / Q000601:surgery*; D013163:Splenomegaly / Q000601:surgery*
keywords: Laparoscopic splenectomy; Single-port splenectomy; Splenic artery embolization; Splenic size in childhood; Splenomegaly