A case controlled comparison of open and laparoscopic splenectomy in children

Frederick Rescorla, Phillip P. Breitfeld, Karen W. West, David Williams, Scott A. Engum, Jay L. Grosfeld

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background. This case controlled study compares the efficacy, safety, and cost of laparoscopic splenectomy (LS) and open splenectomy (OS) for hematologic disorders in children. Methods. The records of 82 consecutive children and adolescents undergoing splenectomy for hematologic disorders between August 1994 and September 1997 were reviewed retrospectively. Results. Fifty patients underwent LS by a lateral approach and 32 underwent OS through a left sub costal incision. Mean age was 7.76 years for LS and 6.9 years for OS. Patient weights were similar: (LS, mean 30.5 kg; OS, mean 27.6 kg). Hematologic indications included hereditary spherocytosis in 43 children (LS 26, OS 17), sickle cell anemia with sequestration in 13 (LS 7, OS 6), immune thrombocytopenic purpura in 14 (LS 8, OS 6), and 12 with other disorders (LS 9, OS 3). Concomitant cholecystectomy was performed in 10 of 50 LS and 6 of 32 OS cases. Accessory spleens were identified in 8 of 32 (25%) OS and 9 of 50 (18%) LS cases (P = .578). No LS procedures required conversion to OS. The mean estimated blood loss was 54.4 mL for LS and 49.0 mL for OS (P = .233). LS required a longer operative time (115 vs 83 minutes, P = .002), less need for postoperative intravenous narcotic (51% vs 100%, P < .0001), lower total narcotic doses (0.239 vs 0.480 mg/kg morphine, P = .006), shorter length of hospital stay (1.4 ± 0.97 vs 2.5 ± 1.43 days, P = .0001), and lower average total hospital charges ($5713 vs $6564) than OS. There were no deaths or major complications in either group. Conclusions. Laparoscopic splenectomy is a safe and effective procedure in children with hematologic disorders resulting in longer operative times, less narcotic administration, shorter length of stay, and lower total hospital charge.

Original languageEnglish
Pages (from-to)670-676
Number of pages7
JournalSurgery
Volume124
Issue number4
DOIs
StatePublished - 1998

Fingerprint

Splenectomy
Narcotics
Hospital Charges
Length of Stay
Operative Time

ASJC Scopus subject areas

  • Surgery

Cite this

Rescorla, F., Breitfeld, P. P., West, K. W., Williams, D., Engum, S. A., & Grosfeld, J. L. (1998). A case controlled comparison of open and laparoscopic splenectomy in children. Surgery, 124(4), 670-676. https://doi.org/10.1067/msy.1998.91223

A case controlled comparison of open and laparoscopic splenectomy in children. / Rescorla, Frederick; Breitfeld, Phillip P.; West, Karen W.; Williams, David; Engum, Scott A.; Grosfeld, Jay L.

In: Surgery, Vol. 124, No. 4, 1998, p. 670-676.

Research output: Contribution to journalArticle

Rescorla, F, Breitfeld, PP, West, KW, Williams, D, Engum, SA & Grosfeld, JL 1998, 'A case controlled comparison of open and laparoscopic splenectomy in children', Surgery, vol. 124, no. 4, pp. 670-676. https://doi.org/10.1067/msy.1998.91223
Rescorla, Frederick ; Breitfeld, Phillip P. ; West, Karen W. ; Williams, David ; Engum, Scott A. ; Grosfeld, Jay L. / A case controlled comparison of open and laparoscopic splenectomy in children. In: Surgery. 1998 ; Vol. 124, No. 4. pp. 670-676.
@article{d751de762f854db487007c384c49900e,
title = "A case controlled comparison of open and laparoscopic splenectomy in children",
abstract = "Background. This case controlled study compares the efficacy, safety, and cost of laparoscopic splenectomy (LS) and open splenectomy (OS) for hematologic disorders in children. Methods. The records of 82 consecutive children and adolescents undergoing splenectomy for hematologic disorders between August 1994 and September 1997 were reviewed retrospectively. Results. Fifty patients underwent LS by a lateral approach and 32 underwent OS through a left sub costal incision. Mean age was 7.76 years for LS and 6.9 years for OS. Patient weights were similar: (LS, mean 30.5 kg; OS, mean 27.6 kg). Hematologic indications included hereditary spherocytosis in 43 children (LS 26, OS 17), sickle cell anemia with sequestration in 13 (LS 7, OS 6), immune thrombocytopenic purpura in 14 (LS 8, OS 6), and 12 with other disorders (LS 9, OS 3). Concomitant cholecystectomy was performed in 10 of 50 LS and 6 of 32 OS cases. Accessory spleens were identified in 8 of 32 (25{\%}) OS and 9 of 50 (18{\%}) LS cases (P = .578). No LS procedures required conversion to OS. The mean estimated blood loss was 54.4 mL for LS and 49.0 mL for OS (P = .233). LS required a longer operative time (115 vs 83 minutes, P = .002), less need for postoperative intravenous narcotic (51{\%} vs 100{\%}, P < .0001), lower total narcotic doses (0.239 vs 0.480 mg/kg morphine, P = .006), shorter length of hospital stay (1.4 ± 0.97 vs 2.5 ± 1.43 days, P = .0001), and lower average total hospital charges ($5713 vs $6564) than OS. There were no deaths or major complications in either group. Conclusions. Laparoscopic splenectomy is a safe and effective procedure in children with hematologic disorders resulting in longer operative times, less narcotic administration, shorter length of stay, and lower total hospital charge.",
author = "Frederick Rescorla and Breitfeld, {Phillip P.} and West, {Karen W.} and David Williams and Engum, {Scott A.} and Grosfeld, {Jay L.}",
year = "1998",
doi = "10.1067/msy.1998.91223",
language = "English",
volume = "124",
pages = "670--676",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - A case controlled comparison of open and laparoscopic splenectomy in children

AU - Rescorla, Frederick

AU - Breitfeld, Phillip P.

AU - West, Karen W.

AU - Williams, David

AU - Engum, Scott A.

AU - Grosfeld, Jay L.

PY - 1998

Y1 - 1998

N2 - Background. This case controlled study compares the efficacy, safety, and cost of laparoscopic splenectomy (LS) and open splenectomy (OS) for hematologic disorders in children. Methods. The records of 82 consecutive children and adolescents undergoing splenectomy for hematologic disorders between August 1994 and September 1997 were reviewed retrospectively. Results. Fifty patients underwent LS by a lateral approach and 32 underwent OS through a left sub costal incision. Mean age was 7.76 years for LS and 6.9 years for OS. Patient weights were similar: (LS, mean 30.5 kg; OS, mean 27.6 kg). Hematologic indications included hereditary spherocytosis in 43 children (LS 26, OS 17), sickle cell anemia with sequestration in 13 (LS 7, OS 6), immune thrombocytopenic purpura in 14 (LS 8, OS 6), and 12 with other disorders (LS 9, OS 3). Concomitant cholecystectomy was performed in 10 of 50 LS and 6 of 32 OS cases. Accessory spleens were identified in 8 of 32 (25%) OS and 9 of 50 (18%) LS cases (P = .578). No LS procedures required conversion to OS. The mean estimated blood loss was 54.4 mL for LS and 49.0 mL for OS (P = .233). LS required a longer operative time (115 vs 83 minutes, P = .002), less need for postoperative intravenous narcotic (51% vs 100%, P < .0001), lower total narcotic doses (0.239 vs 0.480 mg/kg morphine, P = .006), shorter length of hospital stay (1.4 ± 0.97 vs 2.5 ± 1.43 days, P = .0001), and lower average total hospital charges ($5713 vs $6564) than OS. There were no deaths or major complications in either group. Conclusions. Laparoscopic splenectomy is a safe and effective procedure in children with hematologic disorders resulting in longer operative times, less narcotic administration, shorter length of stay, and lower total hospital charge.

AB - Background. This case controlled study compares the efficacy, safety, and cost of laparoscopic splenectomy (LS) and open splenectomy (OS) for hematologic disorders in children. Methods. The records of 82 consecutive children and adolescents undergoing splenectomy for hematologic disorders between August 1994 and September 1997 were reviewed retrospectively. Results. Fifty patients underwent LS by a lateral approach and 32 underwent OS through a left sub costal incision. Mean age was 7.76 years for LS and 6.9 years for OS. Patient weights were similar: (LS, mean 30.5 kg; OS, mean 27.6 kg). Hematologic indications included hereditary spherocytosis in 43 children (LS 26, OS 17), sickle cell anemia with sequestration in 13 (LS 7, OS 6), immune thrombocytopenic purpura in 14 (LS 8, OS 6), and 12 with other disorders (LS 9, OS 3). Concomitant cholecystectomy was performed in 10 of 50 LS and 6 of 32 OS cases. Accessory spleens were identified in 8 of 32 (25%) OS and 9 of 50 (18%) LS cases (P = .578). No LS procedures required conversion to OS. The mean estimated blood loss was 54.4 mL for LS and 49.0 mL for OS (P = .233). LS required a longer operative time (115 vs 83 minutes, P = .002), less need for postoperative intravenous narcotic (51% vs 100%, P < .0001), lower total narcotic doses (0.239 vs 0.480 mg/kg morphine, P = .006), shorter length of hospital stay (1.4 ± 0.97 vs 2.5 ± 1.43 days, P = .0001), and lower average total hospital charges ($5713 vs $6564) than OS. There were no deaths or major complications in either group. Conclusions. Laparoscopic splenectomy is a safe and effective procedure in children with hematologic disorders resulting in longer operative times, less narcotic administration, shorter length of stay, and lower total hospital charge.

UR - http://www.scopus.com/inward/record.url?scp=0031687850&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031687850&partnerID=8YFLogxK

U2 - 10.1067/msy.1998.91223

DO - 10.1067/msy.1998.91223

M3 - Article

C2 - 9780987

AN - SCOPUS:0031687850

VL - 124

SP - 670

EP - 676

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 4

ER -