Pediatric laparoscopic splenectomy

Background: Lateral laparoscopic splenectomy in adults, first reported in 1 991, was begun with children in 1993. Methods: The authors reviewed records of 59 patients 2 to 17 years old who underwent laparoscopic splenectomy by the lateral approach between 1994 and 1998 at four medical centers. Patients received prophylactic penicillin or vaccinations preoperatively. Results: Of the 59 patients, 51 required splenectomy for one of the followi ng conditions: idiopathic thrombocytopenic purpura, hereditary spherocytosi s, or sickle-cell disease. Splenomegaly was found in 86% of the patients, a nd ten accessory spleens were resected. No deaths or infection occurred, an d only three patients had perioperative complications: acute chest crisis, small diaphragmatic injury, and intraoperative hemorrhage. One operation wa s converted to a minilaparatomy because of difficulty with specimen extract ion. Conclusions: Pediatric laparoscopic splenectomy is safe and effective, resu lting in little blood loss, rapid recovery, and a good cosmetic outcome.