A CASE-CONTROLLED COMPARISON OF OPEN AND LAPAROSCOPIC SPLENECTOMY IN CHILDREN

Background. This case controlled study compares the efficacy safety, a nd cost of laparoscopic splenectomy (LS) and open splenectomy (OS) for hematologic disorders in children. Methods. The records of 82 consecu tive children and adolescents undergoing splenectomy for hematologic d isorders between August 1994 and September 1997 were reviewed retrospe ctively. Results. Fifty patients underwent LS by a lateral approach an d 32 underwent OS through a left subcostal incision. Mean age was 7.76 years for LS and 6.9 years for OS. Patient weights were similar (LS, mean 30.5 kg; OS, mean 27.6 kg). Hematologic indications included here ditary spherocytosis in 43 children (LS 26, OS 17), sickle cell anemia with sequestration in 13 (LS 7, OS 6), immune thrombocytogenic purpur a in 14 (LS 8 OS 6), and 12 with other disorders (LS 9, OS 3). Concomi tant cholecystectomy was performed in 10 of 50 LS and 6 of 32 OS cases . Accessory spleens were identified in 8 of 32 (25 %) OS and 9 of 50 ( 18 %) LS cases (P = .578). No LS procedures required conversion to OS. The mean estimated blood loss was 54.4 mL for LS and 49.0 mL for OS ( P = .233). LS required a longer operative time (115 vs 83 minutes, P = .002), less need for postoperative intravenous narcotic (51% vs 100%, P < .0001), lower total narcotic doses (0.239 vs 0.480 mg/kg morphine , P = .006), shorter length of hospital stay (1.4 +/- 0.97 vs 2.5 +/- 1.43 days, P = .0001), and lower average total hospital charges $5713 vs $6564) than OS. There were no deaths or major complications in eith er group. Conclusions. Laparoscopic splenectomy is a safe and effectiv e procedure in children with hematologic disorders resulting in longer operative times, less narcotic administration, shorter length of stay , and lower total hospital charge.