Laparoscopic splenectomy in children with hematological disorders: Preliminary experience at the children's hospital of New Orleans

Minimally invasive surgery has recently gained acceptance as the surgical a pproach of choice for a variety of surgical disorders in children. Although traditional open surgery is still regarded as the standard approach for a splenectomy in children when necessary for hematologic disorders a few case s of successful laparoscopic splenectomy (LS) have been reported, We presen t our initial 11 cases of LS in children assessing surgical outcome. Eleven patients ages 2 through 15 years underwent LS between June of 1996 and Jul y of 1999 at the Children's Hospital of New Orleans. Indications for surger y included idiopathic thrombocytopenic purpura, congenital spherocytosis, a nd hemolytic anemia. In all patients the diameter of the spleen was less th an 15 cm. Surgical outcome was assessed according to the following paramete rs: operative time, postoperative length of stay, postoperative morbidity, and cosmetic results. Data were accumulated on the basis of retrospective c hart review. LS was completed in all 11 patients. Postoperative morbidity w as minimal and the median postoperative stay was 2.4 days (range 1-5). Mean operative time was 3 hours and 10 minutes (range 1.5-7 hours) with the las t six procedures completed in an average of just over 2 hours. Intravenous analgesia was discontinued in <48 hours in all patients. Cosmetic results w ere judged excellent in all cases. We conclude that LS was safe in children with certain hematologic disorders. Adequate selection of patients, approp riate preoperative preparation of patients, meticulous surgical technique, and careful postoperative care were key factors in obtaining the same long- term results as with open surgery.