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Mini-Laparotomy for Splenectomy in Children: An Excellent Mini-Invasive Alternative to Laparoscopic Approach (Abstract)

Esposito C., Alicchio F., Ascione G., Sammarco G., and Settimi A.

Chair of Pediatric Surgery, “Federico II” University, Naples, Italy

Chair of Pediatric Surgery, Magna Graecia University, Catanzaro, Italy



Background: Laparoscopic splenectomy is frequently performed to treat various haematological and autoimmune disorders in children. This study underlines the efficacy and safety of minimal sub-costal incision to perform splenectomy in children with haematological disorders.

Materials and methods: We analyzed the data of 31 consecutive children who underwent splenectomy for haematological disorders in our Unit between January 2000 and January 2006. The patients were 19 girls and 12 boys whose ages ranged between 4 and 14 years (median, 7.5 years). Their weight ranged from 15 to 49 kg (median 23 kg). The indications for splenectomy were hereditary spherocytosis (11 cases), b-thalassemia (10 cases), idiopathic thrombocytopenic purpura (7 cases), and sickle cell disease ( 3 cases). All children had been vaccinated against pneumococcal and meningococcal infections 1 month before surgery. Eight children presented with an associated cholelitiasis and were cholecystectomized via laparoscopy during the same anaesthesia.

Results: The size of the spleen at preoperative US was on average 14 ± 2.0 cm, (16 ± 2.5 cm along its longitudinal axis) and weighed 550 ± 55.1 gr. Operating time was 35±10 minutes for splenectomy alone ± 20-25 min. in patients who also underwent an associated cholecystectomy. No complications were recorded. In 3 children there was a breakage of the splenic capsula after extraction of the spleen. Post-operative analgesia was necessary for 24-48 hours in all patients; hospital stay was 3.0 ± 1 days.

Conclusion: Based on our large experience, we believe that the open approach via a minimal sub-costal incision is a safe and effective mini-invasive procedure to perform splenectomy in children. In case of coexisting cholelytiasis, the cholecystectomy can be performed laparoscopically during the same anaesthesia.


Key words: spleen, laparoscopic splenectomy, minimally invasive surgery



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