Laparoscopic Splenectomy

  • Catarina Barroso
  • Jorge Correia-PintoEmail author


In the pediatric age group, splenectomy has been performed mostly for hematologic disorders, such as hereditary spherocytosis, idiopathic thrombocytopenic purpura, and sickle cell anemia. Throughout the history of splenectomy, two major events influenced clinical practice to what it is today. Those were (1) the realization of children’s susceptibility to infection after splenectomy, by King and Shumaker in 1952, leading pediatric physicians to embrace conservative approaches for splenic diseases and injuries [1], and (2) the advent of laparoscopic splenectomy first described for adults, by Delaitre in 1991 [2], and then for children, by Tulman in 1993 [3]. Reduced postoperative pain, shorter length of stay, and improved cosmesis made laparoscopic splenectomy the standard of care when spleen removal is indicated [1, 2]. Over the years, there were reports of increased costs (for longer operative time) and inadequate detection of accessory spleens and splenosis [2, 3]. These were overcome by more recent studies, including a meta-analysis from 2016, revealing lower overall costs (considering shorter hospitalization), less blood loss, similar rate of removal of accessory spleens, and postoperative complications. Conversion rates in pediatric series range from 0 to 6% and have been mainly for bleeding and splenomegaly [1, 2]. Nevertheless, similar postoperative outcomes have been reported for enlarged spleens, except for operative time.


Conflicts of Interest

Jorge Correia-Pinto is an international Karl Storz Gmbh & Co. KG consultant for training and education in minimally invasive pediatric surgery.


  1. 1.
    King H, Shumacker HB. Splenic studies. I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952;136(2):239–42.CrossRefGoogle Scholar
  2. 2.
    Delaitre B, Maignien B. Splenectomy by the coelioscopic approach: report of a case. Presse Med. 1991;20:2263.PubMedGoogle Scholar
  3. 3.
    Tulman S, Holcomb GW III, Karamanoukian HL, Reynhout J. Pediatric laparoscopic splenectomy. J Pediatr Surg. 1993;28(5):689–92.CrossRefGoogle Scholar
  4. 4.
    Rescorla FJ, Engum SA, West K, Tres Scherer LR III, Rouse TM, Grosfeld JL. Laparoscopic splenectomy has become the gold standard in children. Ann Surg. 2002;68(3):297–301.Google Scholar
  5. 5.
    Janu PG, Rogers DA, Lobe TE. A comparison of laparoscopic and traditional open splenectomy in childhood. J Pediatr Surg. 1986;31(1):109–14.CrossRefGoogle Scholar
  6. 6.
    Feng S, Qiu Y, Li X, et al. Laparoscopic versus open splenectomy in children: a systematic review and meta-analysis. Pediatr Surg Int. 2016;32(3):253–9.CrossRefGoogle Scholar
  7. 7.
    Rescorla FJ, Breitfeld PP, West KW, Williams D, Engum SA, Grosfeld JL. A case controlled comparison of open and laparoscopic splenectomy in children. Surgery. 1998;124(4):670–6.CrossRefGoogle Scholar
  8. 8.
    Coccolini F, Montori G, Catena F, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017;12(1):1–26.CrossRefGoogle Scholar
  9. 9.
    Bruzoni M, Dutta S. Single-site umbilical laparoscopic splenectomy. Semin Pediatr Surg. 2011;20(4):212–8.CrossRefGoogle Scholar
  10. 10.
    Al-Salem AH. Indications and complications of splenectomy for children with sickle cell disease. J Pediatr Surg. 2006;41(11):1909–15.CrossRefGoogle Scholar
  11. 11.
    Wu Z, Zhou J, Pankaj P, Peng B. Comparative treatment and literature review for laparoscopic splenectomy alone versus preoperative splenic artery embolization splenectomy. Surg Endosc. 2012;26(10):2758–66.CrossRefGoogle Scholar
  12. 12.
    Garey CL, Laituri CA, Ostlie DJ, et al. Single-incision laparoscopic surgery in children: initial single-center experience. J Pediatr Surg. 2011;46(5):904–7.CrossRefGoogle Scholar
  13. 13.
    Owusu-Ofori S, Riddington C. Splenectomy versus conservative management for acute sequestration crises in people with sickle cell disease. [Review]. Cochrane Database Syst Rev. 2017;(11):CD003425.Google Scholar
  14. 14.
    Soyer T, Ciftci AO, Tanyel FC, Şenocak ME, Büyükpamukçu N. Portal vein thrombosis after splenectomy in pediatric hematologic disease: risk factors, clinical features, and outcome. J Pediatr Surg. 2006;41(11):1899–902.CrossRefGoogle Scholar
  15. 15.
    Luoto TT, Pakarinen MP, Koivusalo A. Long-term outcomes after pediatric splenectomy. Surgery. 2016;159(6):1583–90.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Pediatric Surgery DepartmentHospital de BragaBragaPortugal
  2. 2.Life and Health Sciences Research Institute (ICVS), School of MedicineUniversity of MinhoBragaPortugal
  3. 3.ICVS/3B’s—PT Government Associate LaboratoryBraga/GuimarãesPortugal

Personalised recommendations