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Laparoscopic Splenectomy for Children With Hematological Disorders: Our Initial Experience With 45 Cases (Abstract)

Abdulla Alwabari*, Lalit Parida*, Ahmed H. Al-Salem**

*Department of Surgery, Division of Pediatric Surgery, King Fahad Specialist Hospital

**Department of Pediatric Surgery, Maternity and Children Hospital,

Dammam, Saudi Arabia

 

Abstract

Background: In 1991, Delaitre reported the first laparoscopic splenectomy. Since than laparoscopic splenectomy has become the procedure of choice to treat hematological diseases requiring splenectomy. The Eastern Province of Saudi Arabia is known to have a high incidence of hemoglobinopathies which necessitate splenectomy. This report describes our initial experience with laparoscopic splenectomy for children with various hematological disorders.

Material and Methods: The medical records of all children who had laparoscopic splenectomy at our hospital were retrospectively reviewed for age, sex, indication for splenectomy, operative time, hospital stay and postoperative complications. The results were compared to a similar group of children who had open splenectomy with or without cholecystectomy.

Results: Over a period of 3.5 years between January 2005 and June 2008, a total of 45 children had laparoscopic splenectomy with or without cholecystectomy. Their age ranged from 2 years - 12 years (mean 7 years). There were 23 males and 22 females. The indications for splenectomy were: sickle cell disease (30), B-thalassemia major (5), thalassemia intermediate (4) ITP (5) and autoimmune hemolytic anemia (1). Thirty-seven children had laparoscopic splenectomy only and 8 had laparoscopic splenectomy and cholecystectomy. The operative time ranged from 1.5 hours – 9 hours (mean 2.75 hours). Their hospital stay ranged from 3 days – 10 days (mean 4.5 days). There was no mortality. Three patients (6.7%) required conversion to open splenectomy. In one because of a very large size spleen and severe adhesions, and in the other two because of intra-operative bleeding. The results in term of operative time, hospital stay and postoperative complications were compared to a similar group of 45 children who had open splenectomy (37) with or without cholecystectomy (8).

Conclusions: Laparoscopic splenectomy is feasible and safe in children with hematological disorders in general and sickle cell disease in particular and can be done concomitantly with cholecystectomy. Currently, it requires more operative time than the open approach. This is specially so for children with sickle cell disease who are known to have large spleens with severe adhesions. It is however superior to open splenectomy with regard to duration of hospital stay, cosmetic appearance and post-operative complications.

Key words: laparoscopic splenectomy, cholecystectomy, hemoglobinopathies

 

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