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.