Laparoscopic versus open splenectomy in children with benign hematological diseases in children: a single-center experience

Abstract

Introduction: Splenectomy whether open or laparoscopic addresses the role of the spleen in the hematology disorders, particularly that of the cellular sequestration and destruction and antibody production. Laparoscopic splenectomy (LS) has been increasingly used for the removal of spleen in children. However, there are still certain questions as regards the feasibility, economic reflections, appropriate splenic size suitable for LS, vascular control of that organ, and final outcomes related to either procedure.

Patients and methods: In the period between May 2007 and March 2017, 70 children with benign hematological diseases underwent splenectomy, either laparoscopic or open. They were divided into group A and group B. Group A included cases who had LS, and group B included cases who had open splenectomy (OS). We performed LS while the child was in the right lateral position. In cases of normal splenic size, we used three ports and four ports in cases of splenomegaly. OS was performed in supine position.

Results: A total of 70 children were subjected to splenectomy, of whom 20 were boys and 50 were girls. Thalassemia was present in 36 cases, idiopathic thrombocytopenic purpura in 24 cases, and spherocytosis in 10 cases. Five cases were converted to the traditional approach, and three of them were because of huge splenomegaly and two cases were because of accidental bleeding. In the LS group, small-sized spleens were extracted using retrieval bags, whereas large spleens were extracted through Pfannenstiel incision. OS procedure was performed through midline incision. Cholecystectomy was performed in five cases during the original procedure because of gall bladder stones: three cases in group A and two cases in group B.

Conclusion: Although both LS and OS achieved the same goal for the children with benign hematological disease, the advantages of minimal invasive surgery made LS the standard approach for treatment of children with benign hematological diseases. However, the main concern is the high economic burden of LS when compared with OS.

Keywords: children, laparoscopic, open, splenectomy