|Laparoscopic Splenic Procedures In Children: Experience In 231 Children|
|Frederick J Rescorla, Karen W West*, Scott A Engum*, Jay L Grosfeld |
Indiana University School of Med, Indianapolis, IN
|OBJECTIVE(S): The purpose of this report is to evaluate the efficacy of and complications observed following laparoscopic splenic procedures in children.|
METHODS: Review of a prospective database at a single institution (1995-2006) identified 231 children (129 boys; 102 girls; avr age 7.69 yrs) undergoing laparoscopic splenic procedures.
RESULTS: Two hundred twenty three children underwent laparoscopic splenectomy (211 total; 12 partial) by the lateral approach. Indication for splenectomy was hereditary spherocytosis (111), immune thrombocytopenic purpura (36), sickle cell disease (SCD)(51) and other (25). Four (2%) required conversion to an open procedure. Eight additional laparoscopic splenic procedures were performed: splenic cystectomy for epithelial (4) or traumatic (2) cyst, and splenopexy for wandering spleen (2). Average length of stay was 1.5 days. Complications (11% overall, 22% in SCD patients) included ileus (5), bleeding (4), acute chest syndrome (5), pneumonia (2), portal vein thrombosis (1), priapism (1), hemolytic uremic syndrome (1), diaphragm perforation (2), colonic injury (1), missed accessory spleen (1), trocar site hernia (1), subsequent total splenectomy after an initial partial (1) and recurrent cyst (1). Subsequent operations were open in 3 (colon repair, hernia, missed accessory spleen) and laparoscopic in two (completion splenectomy, cyst excision). There were no deaths, wound infections or instances of pancreatitis.
CONCLUSIONS: Laparoscopic splenic procedures are safe and effective in children and are associated with low morbidity, higher complication rate in SCD, low conversion rate, zero mortality and short length of stay. LS has become the procedure of choice for most children requiring a splenic procedure.
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