Laparoscopic splenectomy was initially reported in children in 1993 (Tulman et al. 1993) and since then has become the preferred technique at most institutions. The primary advantages cited for the laparoscopic approach include decreased postoperative pain medication requirement, less intestinal ileus, shorter postoperative hospital stay, and an improved cosmetic appearance. Operative times are usually longer with the laparoscopic approach and in addition to an initial steep learning curve the procedure may be difficult in cases of splenomegaly. Although some reports have questioned the efficacy of accessory spleen detection and potential for residual splenic function if capsular disruption occurs (Gigot et al. 1998; Targarona et al. 1998), most pediatric series have had comparable accessory spleen detection rates between open and laparoscopic cases (Minkes et al. 2000; Moores et al. 1995; Rescorla et al. 1996; Waldhausen and Tapper 1997).
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