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Laparoscopic Partial Splenectomies in Children for Hereditary Spherocytosis (Abstract)

P. de Lagausie*, D. Kalfa*, I. Thuret**, S. Le Bel***, J.M. Guys*.
* Visceral Pediatric Surgery Department, Hôpital de la Timone Enfants, Marseille, France.
** Hematologic Pediatric Department, Hôpital de la Timone Enfants, Marseille, France.
*** Anesthesiology and Pediatric intensive Care Department, Hôpital de la Timone Enfants, Marseille, France.



Background: The two main surgical options proposed in the hereditary spherocytosis in children used to be laparoscopic total splenectomy or open partial splenectomy. The aim of this study was to describe the feasibility and the results of laparoscopic partial splenectomy in children with hereditary spherocytosis.

Material and methods: This retrospective study included 3 cases (2 boys, 1 girl). The mean age was 5,3 years (range from 23 months to 8 years). The mean weight was 19 kg (range from 11 to 26 kg). Surgery was decided on anaemia (mean preoperative haemoglobin count: 90 g/l) in the three cases. Two patients had 10 or more transfusions before partial splenectomy. The mean spleen size was 12,7 cm X 7,5 cm.

Results: During the surgical procedure, 80-90% of the splenic tissue was removed by anterior approach, and the splenic remnant was conserved in the lower part in the 3 cases. Ultracision Harmonic Scalpel (® Ethicon, Cincinnati, USA) was used to complete transection of the spleen. The mean time for laparoscopic resection was 140 minutes (range from 75 to 180 min). No per-operative complications occurred: no bleeding, no diaphragmatic injury. Neither per-operative transfusion nor conversion were necessary. One postoperative complication (left pleural effusion) occurred but required no further treatment. The mean hospital stay was 4,6 days (range from 3 to 7 days). None of them needed postoperative blood transfusion. No post-splenectomy infectious complication occurred. Mean follow-up time was 41,7 months (range from 37 to 49 months). 

Conclusion: Laparoscopic partial splenectomy is feasible and safe in children with hereditary spherocytosis, essentially due to the use of Ultracision Harmonic Scalpel. This surgical procedure offers advantages of both laparoscopic technique and preservation of splenic tissue. A longer follow-up would be useful to evaluate the potential risk of regrowth of the splenic remnant after partial laparoscopic splenectomy. 

Key words: laparoscopic partial splenectomy, hereditary spherocytosis, children



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