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Is expertise in pediatric surgery necessary to perform laparoscopic splenectomy in children? An experience from a department of general surgery

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A Letter to the Editor to this article was published on 30 November 2012

Abstract

Splenectomy is frequently required in children for various hematologic pathologic findings. Because of progress in minimally invasive techniques, laparoscopic splenectomy (LS) has become feasible. The objective of this report is to present a monocentric experience and to evaluate the efficacy of and complications observed after laparoscopic splenic procedures in a department of general surgery. 57 consecutive LSs have been performed in a pediatric population between January 2000 and October 2010. There were 33 females and 24 males with a median age of 12 years (range 4–17). Indications were: hereditary spherocytosis 38 cases, idiopathic thrombocytopenic purpura 10, sickle cell disease (SCD) 6, thrombocytopenic thrombotic purpura 2 and non-hodgkin lymphoma 1 case. Patients were operated on using right semilateral position, employing Atlas Ligasure vessel sealing system in 49 cases (86%) and Harmonic Scalpel + EndoGIA in 8. In 24 patients (42.1%), a cholecystectomy was associated. Two patients required conversion to open splenectomy (3.5%). In three cases, a minilaparotomy was performed for spleen removal (5.2%). Accessory spleens were identified in three patients (5.2%). Complications (8.8%) included bleeding (two), abdominal collection (one) and pleural effusion (two). There was no mortality. Average operative time was 128 min (range 80–220). Average length of stay was 3 days (range 2–7). Mean blood loss was 80 ml (range 30–500) with a transfusion rate of 1.7% (one patient). Laparoscopic spleen surgery is safe, reliable and effective in the pediatric population with hematologic disorders and is associated with minimal morbidity, zero mortality, and a short length of stay. Ligasure vessel sealing system shortened operative time and blood loss. On the basis of the results, we consider laparoscopic approach the gold standard for the treatment of these patients even in a department of general surgery.

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The authors certify that they have no commercial association that might pose a conflict of interest in connection with the submitted article.

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Authors and Affiliations

  1. Department of Surgery, San Gerardo Hospital, II University of Milan, Bicocca, Monza, Italy

    Marcello Guaglio, Fabrizio Romano, Mattia Garancini, Luca Degrate, Margherita Luperto, Fabio Uggeri, Mauro Scotti & Franco Uggeri

  2. Department of General Surgery (Chirurgia I), San Gerardo Hospital, University of Milan Bicocca, via Donizetti, 106 20052, Monza, Italy

    Fabrizio Romano

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  1. Marcello Guaglio
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  2. Fabrizio Romano
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Correspondence to Fabrizio Romano.

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Guaglio, M., Romano, F., Garancini, M. et al. Is expertise in pediatric surgery necessary to perform laparoscopic splenectomy in children? An experience from a department of general surgery. Updates Surg 64, 119–123 (2012). https://doi.org/10.1007/s13304-011-0130-3

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  • DOI: https://doi.org/10.1007/s13304-011-0130-3

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