Laparoscopic splenectomy in children: experience from a tertiary care referral institute in North India

Abstract

The aim of this study was to compare the results of laparoscopic splenectomy (LS) with open splenectomy (OS) in children at a tertiary care referral institute in North India. The electronic medical records of all children who had undergone non-emergent splenectomies between July 2014 and December 2019 at our centre were reviewed retrospectively. Patients undergoing splenectomies for trauma or portal hypertension were excluded. During the period from July 2014 to June 2016, splenectomy was performed by an open technique. From July 2016 onwards, all splenectomy procedures were performed laparoscopically. Demographic features, indications for splenectomy, operative time, estimated blood loss, spleen weight, need for conversion, length of stay, time to oral feeds and requirement for analgesia were recorded. Data for children undergoing LS were compared with those undergoing OS. Between July 2014 and June 2016, 20 children underwent OS. Between July 2016 and November 2019, 16 children underwent LS. The groups were similar in age and sex; hereditary spherocytosis was the commonest indication in both the groups. Operating time was longer in the LS group (186 ± 20.4 min vs 136 ± 12.2 min; P < 0.05), but blood loss and complication rates were similar. Two (12.5%) conversions were necessary, primarily due to spleen size. Children undergoing LS had a shorter length of stay (3.4 ± 0.6 vs 6.8 ± 1.2 days; P < 0.05), shorter time to oral feeds (0.5 vs 2.5 days; P < 0.05), and lesser requirement for analgesia. LS is feasible and safe in children. It is superior to OS with regard to cosmesis, duration of postoperative analgesia, duration of hospital stay, and recovery of bowel function. However, operating time for LS is longer than OS at our centre currently.