Long-Term Outcome After Partial Splenectomy Compared to Total Splenectomy in Children With Spherocytosis

Abstract

Splenectomy may be required for Hereditary Spherocytosis (HS) management. The severe infection risk after total splenectomy (TS) has led to an increasing interest in partial splenectomy (PS). Previous studies suspected that PS may be less effective, but long-term studies are lacking. Here, we compared the long-term efficacy of TS and PS. This French national multicenter retrospective study (2005-2017) included 96 children with a minimum post-surgery follow-up of 5 years. The primary endpoint was the hemoglobin concentration at the follow-up end. Intra- and post-operative complications and completion splenectomy were also reported. TS was performed in 70 patients (72.9 %) and PS in 26. The mean post-surgery follow-up was 8 years (5-17). At the follow-up end, hemoglobin concentration was significantly higher in the TS than PS group (13.86 g/dl ± 1.74 vs 11.87 g/dl ± 1.28, p < 0.01). Postoperative complications were not different, but hospital stay was longer for PS (6.9 ± 2.6 days vs 4.9 ± 2.5 days, p < 0.01). Following PS, completion splenectomy was required in 11/26 patients (42.3 %) after a mean interval of 7 years (first 8 years after PS for 25 % of patients and after 17 years for one patient). Hemoglobin concentration was 11.8 g/dl ± 1.28 after PS and 14.49 g/dl ± 1.34 (p < 0.01) after completion splenectomy, similar to that in the TS group. Hemoglobin concentration <8.5 g/dL was a risk factor of later completion splenectomy (OR = 10; 95 % CI [2.23-100]; p = 0.03). PS is associated with lower hemoglobin concentration and a significant risk of completion splenectomy several years after the initial surgery. Therefore, it requires long-term hemoglobin concentration monitoring, especially if the pre-surgery value is < 8.5 g/dL.

Keywords: Completion; Efficacy; Hereditary spherocytosis; Partial splenectomy; Total splenectomy.