Pediatric Surgery International

, Volume 27, Issue 11, pp 1165–1171

Contemporary pediatric splenectomy: continuing controversies

  • James H. Wood
  • David A. Partrick
  • Taru Hays
  • Angela Sauaia
  • Frederick M. Karrer
  • Moritz M. Ziegler
Original Article

Abstract

Purpose

We undertook the current study to update the literature on pediatric splenectomy in the age of minimally invasive proficiency among pediatric surgeons. The study is designed to address specific concerns among surgeons about the suitability of the laparoscopic approach in specific situations and among hematologists about the relative benefits and risks of splenectomy in children.

Methods

Retrospective analysis of clinicopathologic data for 118 children who underwent open (OS) or laparoscopic (LS) splenectomy at an urban tertiary children’s hospital from January 2000 to July 2008.

Results

One hundred and three cases (87%) were started as LS. Operative times were equivalent for LS and OS (P = 0.8). In the LS group, there were four conversions (3.9%) from LS to OS and five early post-operative complications (4.9%). Median length of stay was 2 days for LS and 4 days for both OS and LS converted to OS (P < 0.0001). The ten largest spleens removed by LS had greater mass (P = 0.02) and tended to have greater volume (P = 0.1) than those removed by OS. Children with hereditary spherocytosis, ITP, and hemoglobinopathy had favorable clinical outcomes, regardless of operative approach. There were no cases of overwhelming post-splenectomy sepsis in this series.

Conclusions

Laparoscopic splenectomy is the preferred approach for splenectomy in children with hematological diseases, with or without splenomegaly. Compared to open splenectomy, laparoscopic splenectomy has equivalent operative time and improved length of stay. Both approaches have excellent therapeutic outcomes for appropriate indications.

Keywords

Pediatric splenectomy Laparoscopic splenectomy Minimally invasive surgery Hereditary spherocytosis Immune thrombocytopenic purpura Congenital hemolytic anemia Overwhelming post-splenectomy sepsis 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • James H. Wood
    • 1
  • David A. Partrick
    • 1
    • 3
  • Taru Hays
    • 2
  • Angela Sauaia
    • 1
  • Frederick M. Karrer
    • 1
    • 3
  • Moritz M. Ziegler
    • 1
    • 3
  1. 1.Department of SurgeryUniversity of Colorado Denver School of MedicineAuroraUSA
  2. 2.Department of Pediatrics, Division of HematologyUniversity of Colorado Denver School of MedicineAuroraUSA
  3. 3.Department of Pediatric SurgeryThe Children’s HospitalAuroraUSA

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