Limits in Laparoscopic Partial Splenectomy in Children

Abstract

The aim of this paper is to assess the effectiveness and perioperative complications of splenic surgeries in children. In 41 splenectomies, an anterior abdominal laparoscopic approach was used, with 35 including a partial laparoscopic splenectomy. Of these, three needed a conversion to open. Six patients had a total splenectomy, three of which were open. Patients ranged in age from 5 to 18 years. Splenectomy was performed for a variety of causes, including hereditary spherocytosis (n = 20), splenic cysts (n = 13), sickle cell disease (n = 3), primary malignancy (n = 1), sepsis (n = 1), embolism (n = 1), anemia (n = 1), and hypersplenism (n = 1). The average length of stay was 7.6 days, and the average operation time was 169.3 min. Pleural effusion in the left hemithorax was found in 31.6% of the patients, with 5.3% requiring a thorax drain. The majority of patients had the highest platelet count two weeks after surgery. There was no evidence of wound infection, pancreatic leak, colon perforation, or postoperative sepsis. The most encountered perioperative complication was bleeding with the need of transfusion (n = 6), and one patient needed a diaphragm repair. A partial splenectomy (PS) can be a difficult procedure with a steep learning curve. For most children who require a splenic operation, this should be the primary procedure of choice.

Splenic hamartomas in children

“…In children with SH, five open PSs, including our case[ 17 , 19 , 21 , 22 ], and two laparoscopic PSs (LPSs) were performed[ 10 , 28 ]. Although the LPS seems to be the most beneficial procedure for SH treatment, reliable data on the risk-benefit ratio of LPS has not yet been precisely defined[ 60 ]. An accurate preoperative image study enables PS planning.…”

Organ-Preserving Interventions in Surgical Correction of Spleen Cysts in Children

“…²ç çðîñòàííÿì äîñòóïíîñò³ ëàïàðîñêî-ï³÷íîãî îáëàäíàííÿ ó êë³í³êàõ, ñàìå òàêèé ï³ä-õ³ä íàáóâຠâñå á³ëüøî¿ ïîïóëÿðíîñò³. ³í ïðèâîäèòü äî ìåíøî¿ õ³ðóðã³÷íî¿ òðàâìè, øâèäêî¿ ðåàá³ë³òàö³¿ â ï³ñëÿîïåðàö³éíîìó ïåð³îä³, â³äì³ííîãî êîñìåòè÷íîãî åôåêòó [14,15,16].…”

“…Due to the improved access to laparoscopic instruments in clinics, this approach is far more popular. It lessens the impact of surgical trauma, speeds up recovery in the postoperative period, and has outstanding cosmetic benefits [14,15,16]. However, a minimally invasive method cannot be effective in all cases.…”