Limits in Laparoscopic Partial Splenectomy in Children

Abstract

The aim of this paper is to assess the effectiveness and perioperative complications of splenic surgeries in children. In 41 splenectomies, an anterior abdominal laparoscopic approach was used, with 35 including a partial laparoscopic splenectomy. Of these, three needed a conversion to open. Six patients had a total splenectomy, three of which were open. Patients ranged in age from 5 to 18 years. Splenectomy was performed for a variety of causes, including hereditary spherocytosis (n = 20), splenic cysts (n = 13), sickle cell disease (n = 3), primary malignancy (n = 1), sepsis (n = 1), embolism (n = 1), anemia (n = 1), and hypersplenism (n = 1). The average length of stay was 7.6 days, and the average operation time was 169.3 min. Pleural effusion in the left hemithorax was found in 31.6% of the patients, with 5.3% requiring a thorax drain. The majority of patients had the highest platelet count two weeks after surgery. There was no evidence of wound infection, pancreatic leak, colon perforation, or postoperative sepsis. The most encountered perioperative complication was bleeding with the need of transfusion (n = 6), and one patient needed a diaphragm repair. A partial splenectomy (PS) can be a difficult procedure with a steep learning curve. For most children who require a splenic operation, this should be the primary procedure of choice.

Keywords: hereditary spherocytosis; laparoscopic splenectomy; partial splenectomy; splenic cysts.

Figure 1

Patients that were operated and included in the study.

Figure 2

(a) Comparison of partial and total splenectomy operation times in minutes. (b) The correlation between the length of stay (days) and the operation time (minutes) is strong, with r = 0.744. (c) The operation time for splenic cysts in relation to the length of stay (days) demonstrates only a weak correlation with an r of 0.525.

Figure 3

(a) The preoperative spleen size was related to the postoperative thrombocyte count, demonstrating a trend of higher thrombocytes postoperatively. (b) There was no association between residual spleen size and postoperative thrombocyte count. (c) The postoperative thrombocyte count was highest at approximately two weeks, followed by a slow fall after 17 days.