Laparoscopic splenic procedures in children

Experience in 231 children

Frederick Rescorla, Karen W. West, Scott A. Engum, Jay L. Grosfeld

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

OBJECTIVES: The purpose of this report is to evaluate the efficacy of and complications observed after laparoscopic splenic procedures in children. METHODS: Review of a prospective database at a single institution (1995-2006) identified 231 children (129 boys; 102 girls; average age 7.69 years) 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, and missed accessory spleen) and laparoscopic in 2 (completion splenectomy, and 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. Laparoscopic splenectomy has become the procedure of choice for most children requiring a splenic procedure.

Original languageEnglish
Pages (from-to)683-687
Number of pages5
JournalAnnals of Surgery
Volume246
Issue number4
DOIs
StatePublished - Oct 2007

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Splenectomy
Sickle Cell Anemia
Cysts
Length of Stay
Wandering Spleen
Spleen
Acute Chest Syndrome
Hereditary Spherocytosis
Priapism
Conversion to Open Surgery
Hemolytic-Uremic Syndrome
Idiopathic Thrombocytopenic Purpura
Ileus
Cystectomy
Herniorrhaphy
Wound Infection
Hernia
Portal Vein
Diaphragm
Surgical Instruments

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic splenic procedures in children : Experience in 231 children. / Rescorla, Frederick; West, Karen W.; Engum, Scott A.; Grosfeld, Jay L.

In: Annals of Surgery, Vol. 246, No. 4, 10.2007, p. 683-687.

Research output: Contribution to journalArticle

Rescorla, Frederick ; West, Karen W. ; Engum, Scott A. ; Grosfeld, Jay L. / Laparoscopic splenic procedures in children : Experience in 231 children. In: Annals of Surgery. 2007 ; Vol. 246, No. 4. pp. 683-687.
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AB - OBJECTIVES: The purpose of this report is to evaluate the efficacy of and complications observed after laparoscopic splenic procedures in children. METHODS: Review of a prospective database at a single institution (1995-2006) identified 231 children (129 boys; 102 girls; average age 7.69 years) 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, and missed accessory spleen) and laparoscopic in 2 (completion splenectomy, and 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. Laparoscopic splenectomy has become the procedure of choice for most children requiring a splenic procedure.

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