COMPARISON OF LAPAROSCOPIC VERSUS OPEN SPLENECTOMY IN CHILDREN

Laparoscopic operative procedures are gaining wider acceptance in pedi atric patients. Although laparoscopic splenectomy is being performed m ore frequently, no studies to date have compared this procedure with t he standard open technique with respect to operative outcomes. We perf ormed a case control study of seven laparoscopic splenectomies and 14 open splenectomies. Two-tailed t test was used to compare the two grou ps for mean operative time, mean hospital stay, mean interval before t olerating a regular diet, and total parenteral narcotic dose in morphi ne equivalents. Operative time was significantly longer in the laparos copic group (221 minutes vs 59 minutes, P < 0.001). Hospital stay, int erval before tolerating a regular diet, and postoperative narcotic dos e did not differ significantly between the two groups. In the laparosc opic group, one operation was converted to an open procedure secondary to bleeding complications. Three patients required mini-laparotomies for removal of extremely large spleens after completion of the dissect ion. Pediatric laparoscopic splenectomy does not appear to have advant ages over the traditional method with regard to operative time, hospit al stay, postoperative ileus, or postoperative pain. Larger studies, i ncluding cost analysis, are needed before major proposed advantages of laparoscopic splenectomy can be accepted.