Laparoscopic versus open splenectomy in children

Background: The authors have reviewed their initial experience with laparos copic splenectomy (LS) to identify the indications, success rate, and compl ications associated with this procedure compared with a series of children undergoing open splenectomy (OS) during the same time period. Methods: The records of 51 children who underwent splenectomy from 1993 thr ough 1998 were reviewed retrospectively. Results: Thirty-five patients aged 1 to 17 years (mean, 9.4 years) underwen t LS for the following indications: ITP (n = 20), sickle cell disease or th alassemia (n = 6), hereditary spherocytosis (n = 5), other hematologic diso rders (n = 4). Seventeen patients aged 2 to 17 years (mean, 11.8 years) und erwent OS during the same time period for]TP (n = 4), sickle cell disease o r thalassemia (n = 4), hereditary spherocytosis (n = 5), and other indicati ons (n = 4). Concomitant cholecystectomy was performed in 4 of 35 LS and 4 of 17 OS. Accessory spleens were identified in 10 of 35 LS and 2 of 17 OS c ases. Eleven spleens were enlarged in the LS group, and 8 were enlarged in the OS group. One LS required conversion to an open procedure because the s pleen did not fit in the bag. No other cases were converted. Median estimat ed blood loss was 50 mt for both the LS and OS groups. The only intraoperat ive complication in the LS group was a splenic capsular tear, which had no effect on the successful laparoscopic removal of the spleen. No patient in either group required a blood transfusion. The LS patients had a shorter le ngth of hospital stay (1.8 +/- 1 versus 4.0 +/- 1 day, P = .0001). Total ho spital charges were not significantly different. Follow-up ranged from 6 to 40 months. One LS patient died 47 days postoperatively from unrelated caus es. Two FS patients had recurrent ITP; accessory spleens were found in one and resected laparoscopically. Conclusion: LS in children can be performed safely with a low conversion ra te (2.9%) and is associated with a shorter hospital stay and comparable tot al hospital cost when compared with OS. Copyright (C) 2000 by W.B. Saunders Company.