title: Operative and Immediate Postoperative Differences Between Traditional Multiport and Reduced Port Laparoscopic Total Splenectomy in Pediatric Patients.
abstract: BACKGROUND
  Laparoscopy offers many benefits to splenectomy, such as reduced incisional pain and shortened hospital duration. The purpose of this study is to evaluate procedural and outcome differences between multiport (MP) and reduced port (RP) splenectomy when utilized to treat children.
  
  
  METHODS
  An institutional review board approved retrospective analysis of all consecutive laparoscopic total splenectomies performed at a single institution between January 2010 and October 2015 was conducted. We evaluated demographics, surgical technique, instance of conversion, operative duration, estimated blood loss, need for intraoperative blood transfusion, postoperative length of stay, time to full feeds, complications, and follow-up duration.
  
  
  RESULTS
  Over a 5-year period, 66 patients less than 20 years of age underwent laparoscopic total splenectomy. RP splenectomy was attempted in 14 patients. The remaining 52 were MP operations. Populations were comparable with regard to demographics. Preoperative splenic volumes (mL) were greater in the RP population (median [IQR]: 1377 [747-1508] versus 452 [242-710], P = .039). RP splenectomy demonstrated no difference compared to MP splenectomy in operative time (153 versus 138 minutes, P = .360), estimated blood loss (120 versus 154 mL, P = .634), or percent of cases requiring intraoperative blood transfusion (14 versus 23, P = .716). By the first postoperative day, 57% of RP and 17% of MP patients could be discharged (P = .005). Thirty-day readmission rates were similar, at 7% for RP and 8% for MP operations. Fever was the indication for all readmissions. Mean duration of follow-up is 28 months for MP and 13 months for RP cases.
  
  
  CONCLUSIONS
  A reduced number of ports can be safely utilized for total splenectomy in pediatric patients without increasing procedural duration or need for intraoperative blood transfusion. In addition, rate of discharge on the first postoperative day was significantly higher in the RP splenectomy group.
authors.affiliation: 1 Department of Surgery, St. Jude Children's Research Hospital , Memphis, Tennessee.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Seims
authors.affiliation: 1 Department of Surgery, St. Jude Children's Research Hospital , Memphis, Tennessee.
authors.forename: Lisa
authors.initials: L
authors.lastname: VanHouwelingen
authors.affiliation: 1 Department of Surgery, St. Jude Children's Research Hospital , Memphis, Tennessee.
authors.forename: Jessica
authors.initials: J
authors.lastname: Mead
authors.affiliation: 2 Department of Biostatistics, St. Jude Children's Research Hospital , Memphis, Tennessee.
authors.forename: Shenghua
authors.initials: S
authors.lastname: Mao
authors.affiliation: 1 Department of Surgery, St. Jude Children's Research Hospital , Memphis, Tennessee.
authors.forename: Amos
authors.initials: A
authors.lastname: Loh
authors.affiliation: 1 Department of Surgery, St. Jude Children's Research Hospital , Memphis, Tennessee.
authors.forename: John A
authors.initials: JA
authors.lastname: Sandoval
authors.affiliation: 1 Department of Surgery, St. Jude Children's Research Hospital , Memphis, Tennessee.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Davidoff
authors.affiliation: 2 Department of Biostatistics, St. Jude Children's Research Hospital , Memphis, Tennessee.
authors.forename: Jianrong
authors.initials: J
authors.lastname: Wu
authors.affiliation: 3 Department of Hematology, St. Jude Children's Research Hospital , Memphis, Tennessee.
authors.forename: Winfred C
authors.initials: WC
authors.lastname: Wang
authors.affiliation: 1 Department of Surgery, St. Jude Children's Research Hospital , Memphis, Tennessee.
authors.forename: Israel
authors.initials: I
authors.lastname: Fernandez-Pineda
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D013154:Spleen / Q000601:surgery*; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: laparoscopy; pediatric; reduced-port; splenectomy