Pediatric Laparoscopic Splenectomy: The Anterior Approach

Abstract

Background and Purpose: Splenectomy is frequently performed in children for various hematologic and autoimmune diseases. We review our indications for splenectomy, our technique of laparoscopic splenectomy using an anterior approach, and our results. Patient and Methods: Between January 1996 and May 2000, 35 children aged 1 to 14 years (mean 7 years) underwent laparoscopic splenectomy. We use an anterior pedicle approach and elective vessel endoligature in order to avoid any exogenous material. Results: Eight patients also had a concomitant cholecystectomy. Fourteen children had hereditary spherocytosis, nine were affected by sickle-cell disease, three had idiopathic thrombocytopenia purpura, two had beta-thalassemia, and seven had another hemolytic disease. One patient was converted to open surgery. The mean operative time was 170 minutes (range 115-230 minutes). Hospital stays ranged from 3 to 15 days (mean 6 days). Five patients had complications (three pneumonia and two deep abscess with successful antibiotic treatment). The median follow-up was 20 months (range 2 months-4 years) without problems related to the procedure. Conclusion: With this technique consisting of first elective arterial and secondary venous ligature, we avoided splenic sequestration of blood and preserved the pancreatic tail. The procedure is safer than the traditional approach. For us, considering the low complication rate for this type of patient and the advantages of minimizing abdominal trauma in the postoperative period, the laparoscopic approach for elective splenectomy and eventual cholecystectomy in hematologic disorders is a technique of choice.