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



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.


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.


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.


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.


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


  1. 1.
    Tulman S, Holcomb GW III, Karamanoukian HL, Reynhout J (1993) Laparoscopic splenectomy. J Pediatr Surg 28:689–692PubMedCrossRefGoogle Scholar
  2. 2.
    Kathkouda N, Hurtwitz MB, Rivera RT et al (1998) Laparoscopic splenectomy: outcome and efficacy in 103 consecutive cases. Ann Surg 228:568–578CrossRefGoogle Scholar
  3. 3.
    Targarona EM, Espert JJ, Balague C et al (1998) Residual splenic functions after laparoscopic splenectomy: a clinical concern. Arch Surg 133:56–60PubMedCrossRefGoogle Scholar
  4. 4.
    Gigot JF, Jamar F, Ferrant A et al (1998) Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy: a shortcoming of the laparoscopic approach in hematologic diseases. Surg Endosc 12:101–106PubMedCrossRefGoogle Scholar
  5. 5.
    Neunert CE, Bright BC, Buchanan GR (2008) Severe refractory immune thrombocytopenic purpura during childhood: a survey of physician management. Pediatr Blood Cancer 5:1513–1516Google Scholar
  6. 6.
    Marazzi A, Paccaud F, Ruffieux C, Beguin C (1998) Fitting the distributions of length of stay by parametric models. Med Care 36:915–927PubMedCrossRefGoogle Scholar
  7. 7.
    Sutherland A, Burghard FF (1910) The treatment of splenic anemia by splenectomy. Lancet 2:1819–1822CrossRefGoogle Scholar
  8. 8.
    Rosen M, Brody F, Walsh RM et al (2002) Outcome of laparoscopic splenectomy based on hematologic indication. Surg Endosc 16:272–279PubMedCrossRefGoogle Scholar
  9. 9.
    Rescorla FJ, Engum SA, West KW et al (2002) Laparoscopic splenectomy has become the gold standard in children. Am Surg 68:297–301PubMedGoogle Scholar
  10. 10.
    Shad AT, Gonzalez CE, Sandler SG (2005) Treatment of immune thrombocytopenic purpura in children: current concepts. Pediatr Drugs 7:325–336CrossRefGoogle Scholar
  11. 11.
    Liu DC, Meyers MO, Hill CB, Loe WA Jr (2000) Laparoscopic splenectomy in children with hematological disorders: preliminary experience at the Children’s Hospital of New Orleans. Am Surg 66:1168–1170PubMedGoogle Scholar
  12. 12.
    Reddy VS, Phan HH, O’Neill JA et al (2001) Laparoscopic versus open splenectomy in the pediatric population: a contemporary single-center experience. Am Surg 67:859–864PubMedGoogle Scholar
  13. 13.
    Sandoval C, Stringel G, Ozkaynak MF et al (2000) Laparoscopic splenectomy in pediatric patients with hematologic diseases. JSLS 4:117–120PubMedGoogle Scholar
  14. 14.
    Park A, Heniford BT, Hebra A, Fitzgerald P (2000) Pediatric laparoscopic splenectomy. Surg Endosc 14:527–531PubMedCrossRefGoogle Scholar
  15. 15.
    Curran TJ, Foley MI, Swanstrom LL, Campbell TJ (1998) Laparoscopy improves outcomes for pediatric splenectomy. J Pediatr Surg 33:1498–1500PubMedCrossRefGoogle Scholar
  16. 16.
    Hicks BA, Thompson WR, Rogers ZR, Guzzetta PC (1996) Laparoscopic splenectomy in childhood hematologic disorders. J Laparoendosc Surg 6:S31–S34PubMedGoogle Scholar
  17. 17.
    Yoshida K, Yamazaki Y, Mizuno R et al (1995) Laparoscopic splenectomy in children. Preliminary results and comparison with the open technique. Surg Endosc 9:1279–1282PubMedCrossRefGoogle Scholar
  18. 18.
    Rescorla FJ, West KW, Engum SA, Grosfield JL (2007) Laparoscopic splenic procedures in children: experience in 231 children. Ann Surg 246:683–688PubMedCrossRefGoogle Scholar
  19. 19.
    Murawskia M, Patkowskib D, Korlackic W et al (2008) Laparoscopic splenectomy in children: a multicenter experience. J Pediatr Surg 43:951–954CrossRefGoogle Scholar
  20. 20.
    Rescorla FJ, Breitfeld PP, West KW et al (1998) A case controlled comparison of open and laparoscopic splenectomy in children. Surgery 124:670–676PubMedCrossRefGoogle Scholar
  21. 21.
    Farah RA, Rogers ZR, Thompson RW et al (1997) Comparison of laparoscopic and open splenectomy in children with hematologic disorders. J Pediatr 131:41–46PubMedCrossRefGoogle Scholar
  22. 22.
    Brunt LM, Langer JC, Quasebarth MA, Whitman ED (1996) Comparative analysis of laparoscopic versus open splenectomy. Am J Surg 172:596–601PubMedCrossRefGoogle Scholar
  23. 23.
    Diaz J, Eisenstat M, Chung R (1997) A case controlled study of laparoscopic splenectomy. Am J Surg 173:348–350PubMedCrossRefGoogle Scholar
  24. 24.
    Esposito C, Corcione F, Ascione G et al (1998) Splenectomy in childhood: the laparoscopic approach. Surg Endosc 12:1445–1448PubMedCrossRefGoogle Scholar
  25. 25.
    Diesen DL, Zimmerman SA, Thornburg CD et al (2008) Partial splenectomy for children with congenital hemolytic anemia and massive splenomegaly. J Pediatr Surg 43:466–472PubMedCrossRefGoogle Scholar
  26. 26.
    Walsh RM, Chand B, Brodsky J, Heniford BT (2003) Determination of intact splenic weight based on morcellated weight. Surg Endosc 17:1266–1268PubMedCrossRefGoogle Scholar
  27. 27.
    Schilling RF (1976) Hereditary spherocytosis: a study of splenectomized persons. Semin Hematol 13:169–176PubMedGoogle Scholar
  28. 28.
    Haricharan RN, Roberts JM, Morgan TL et al (2008) Splenectomy reduces packed red cell transfusion requirement in children with sickle cell disease. J Pediatr Surg 43:1052–1056PubMedCrossRefGoogle Scholar
  29. 29.
    Watts RG (2004) Idiopathic thrombocytopenic purpura: a 10-year natural history study at the Children’s Hospital of Alabama. Clin Pediatr (Phila) 43:691–702CrossRefGoogle Scholar
  30. 30.
    Mantadakis E, Buchanan GR (2000) Elective splenectomy in children with idiopathic thrombocytopenic purpura. J Pediatr Hematol Oncol 22:148–153PubMedCrossRefGoogle Scholar
  31. 31.
    Wood JH, Partrick DA, Hays T, Ziegler MM (2010) Predicting response to splenectomy in children with immune thrombocytopenic purpura. J Pediatr Surg 45:140–144PubMedCrossRefGoogle Scholar
  32. 32.
    Kuhne T, Blanchette V, Buchanan GR et al (2007) Splenectomy in children with idiopathic thrombocytopenic purpura: a prospective study of 134 children from the Intercontinental Childhood ITP Study Group. Pediatr Blood Cancer 49:829–834PubMedCrossRefGoogle Scholar
  33. 33.
    Davis PW, Williams DA, Shamberger RC (1991) Immune thrombocytopenia: surgical therapy and predictors of response. J Pediatr Surg 26:407–413PubMedCrossRefGoogle Scholar
  34. 34.
    Weinblatt ME, Ortega JA (1982) Steroid responsiveness: a predictor of the outcome of splenectomy in children with chronic immune thrombocytopenic purpura. Am J Dis Child 136:1064–1066PubMedGoogle Scholar
  35. 35.
    Holt D, Brown J, Terrill K et al (2003) Response to intravenous immunoglobulin predicts splenectomy response in children with immune thrombocytopenic purpura. Pediatrics 111:87–90PubMedGoogle Scholar
  36. 36.
    Hemmila MR, Foley DS, Castle VP et al (2000) The response to splenectomy in pediatric patients with idiopathic thrombocytopenic purpura who fail high-dose intravenous immune globulin. J Pediatr Surg 35:967–972PubMedCrossRefGoogle Scholar
  37. 37.
    Pearson HA, Johnston D, Smith KA, Touloukian RJ (1978) The born-again spleen. Return of splenic function after splenectomy for trauma. NEJM 298:1389–1392PubMedCrossRefGoogle Scholar
  38. 38.
    Winslow ER, Brunt LM (2003) Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery 134:647–655PubMedCrossRefGoogle Scholar
  39. 39.
    Lynch AM, Kapila R (1996) Overwhelming postsplenectomy infection. Infect Dis Clin North Am 10:693–707PubMedCrossRefGoogle Scholar
  40. 40.
    Brigden ML, Pattulo AL (1999) Prevention and management of overwhelming postsplenectomy infection––and update. Crit Care Med 27:836–842PubMedCrossRefGoogle Scholar
  41. 41.
    Bisharat N, Omari H, Lavi I, Raz R (2001) Risk of infection and death among post-splenectomy patients. J Infect 43:182–186PubMedCrossRefGoogle Scholar
  42. 42.
    Davies JM, Barnes R, Milligan D (2002) Update of guidelines for the prevention and treatment of infecion in patients with an absent or dysfunctional spleen. Clin Med 2:440–443PubMedGoogle Scholar
  43. 43.
    Konradsen HB, Henrichsen J (1991) Pneumococcal infections in splenectomized children are preventable. Acta Paediatrica Scandinavica 80:423–427PubMedCrossRefGoogle Scholar
  44. 44.
    Newland A, Provan D, Myint S (2005) Preventing severe infection after splenectomy. BMJ 331:417–418PubMedCrossRefGoogle Scholar
  45. 45.
    Schwartz P, Sterioff S, Mucha P et al (1982) Postsplenectomy sepsis and mortality in adults. JAMA 248:2279–2283PubMedCrossRefGoogle Scholar
  46. 46.
    Jugenburg M, Haddock G, Freedman M et al (1999) The morbidity and mortality of pediatric splenectomy: does prophylaxis make a difference? J Pediatr Surg 34:1064–1067PubMedCrossRefGoogle Scholar
  47. 47.
    Tracy ET, Rice HE (2008) Partial splenectomy for hereditary spherocytosis. Pediatr Clin N Am 55:503–519CrossRefGoogle Scholar

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

Personalised recommendations