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
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
.