Laparoscopic versus open splenectomy in the pediatric population: A contemporary single-center experience

Citation
Vs. Reddy et al., Laparoscopic versus open splenectomy in the pediatric population: A contemporary single-center experience, AM SURG, 67(9), 2001, pp. 859-863
Citations number
18
Categorie Soggetti
Surgery
Journal title
AMERICAN SURGEON
ISSN journal
00031348 → ACNP
Volume
67
Issue
9
Year of publication
2001
Pages
859 - 863
Database
ISI
SICI code
0003-1348(200109)67:9<859:LVOSIT>2.0.ZU;2-C
Abstract
The purpose of this study was to compare a recent contemporaneous experienc e between laparoscopic (LS) and open (OS) splenectomy in children. All sple nectomy cases between 1994 and 1999 at our institution were reviewed. The s tudy included open and laparoscopic cases performed according to surgeon pr eference. Emergency splenectomies for trauma were excluded. The patient rec ord was reviewed for the diagnosis, indications, postoperative length of st ay, operative technique, postoperative complications, blood loss/blood tran sfusion, total amount of parenteral narcotics, and time to resumption of or al intake. Chi-square and t tests were used to compare measured differences for statistical significance. Between May 1994 and December 1999, 52 splen ectomies were performed at Vanderbilt Children's Hospital. Of these, 45 wer e elective operations with 29 open and 16 laparoscopic procedures. During f our OS and five LS operations a concomitant cholecystectomy was performed. The median patient age was 9.2 years (range 0.5 to 17.3). There was no stat istical difference between the two groups in terms of age, weight, American Society of Anesthesiologists class, or estimated blood loss. There were no immediate postoperative complications in either group. There were no conve rsions from LS to OS. The mean duration of surgery was 264 minutes (LS) ver sus 169 minutes (OS) (P<0.05). The average time to first oral intake was sh orter in patients undergoing LS (1.1 vs 1.6 days, P<0.05) and the mean post operative length of stay was also shorter in the LS group (1.3 vs 3.1 days, P<0.05). The use of postoperative intravenous narcotics (in morphine-equiv alent doses) was significantly less in LS patients than in OS patients (7.5 mg or 0.15 mg/kg vs 46.9 mg or 1.5 mg/kg, P<0.001), as was the need for PC A pump analgesia (90% in the OS group vs 25% in LS group, P<0.01). Overall the average hospital charge (anesthesia fee, narcotics charge, and hospital room charge) was $5400 (range $4240-6250) in the OS group and $4950 (range $4450-6240) in the LS group (P<0.05). Among the nine patients undergoing s plenectomy with cholecystectomy, findings between the OS and LS groups were similar except for one late complication consisting of a diaphragmatic her nia in an LS patient. Both LS and OS with or without a concomitant procedur e can be accomplished safely in children. LS appears to result in longer op erative times but shorter lengths of stay, earlier first oral intake, and s ignificantly fewer requirements for intravenous narcotics; all of these con tribute to a reduction in hospital charges compared with the open operation .