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 , and (2) the advent of laparoscopic splenectomy first described for adults, by Delaitre in 1991 , and then for children, by Tulman in 1993 . 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.
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Conflicts of Interest
Jorge Correia-Pinto is an international Karl Storz Gmbh & Co. KG consultant for training and education in minimally invasive pediatric surgery.
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