THE LATERAL APPROACH FOR OPEN SPLENECTOMY

Background: Laparoscopic splenectomy (LS) has been used increasingly t o treat children with hematologic disorders and has been reported to h ave advantages over open splenectomy performed through a standard Vert ical or subcostal incision. The authors perform open splenectomy(OS) t hrough a lateral, muscle-splitting approach, and believe their approac h is more reasonable in comparison with LS. Methods: Thirty-nine conse cutive open splenectomies performed between 1991 and 1995 were reviewe d retrospectively and compared with recent reports of LS. The series i ncluded 24 boys and 15 girls with an average age of 9 years and averag e weight of 37.5 kg. Indications included immune thrombocytopenic purp ura (n = 20), hereditary spherocytosis (n = 18), and sickle cell anemi a (n = 1). The operation was performed with the child in the lateral d ecubitus position through a left upper abdominal muscle-splitting inci sion (off the 11th rib), sparing the rectus muscle. Results: All 39 ca ses were completed without intraoperative complications with an averag e surgical time of 98.0 minutes (range, 30 to 302). The average surgic al blood loss was 89 mL (range, 10 to 300). The children started feedi ng an average of 1.2 days (range, 0 to 4) postoperatively, were on a r egular diet at an average of 2.0 days (range, 1 to 6) postoperatively, and had an average length of stay of 2.7 days (range, 1 to 6).There w as no mortality or morbidity. Conclusions: Open lateral splenectomy is performed with shorter surgical times, less blood loss, an excellent cosmetic result, no complications, and a length of stay comparable to any of the published series on laparoscopic splenectomy in children. T his approach provides a reasonable basis for comparison with laparosco pic splenectomy. J Pediatr Surg 33:1153-1157. Copyright (C) 1998 by W. B. Saunders Company.