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Laparopscopic Splenectomy: The Procedure of Choice for Children with Sickle Cell Disease - Abstract

Ashraf A. Alnosair, Ahmed H. Al-Salem



Background: Sickle cell disease (SCD) is one of the most common hemoglobinopathies worldwide. The spleen is commonly affected early, leading ultimately to auto-splenectomy as a result of the repeated attacks of vasoocclusive crises. However, this is not always the case and in some patients sple- nomegaly may persist into adulthood leading to complications which necessitate splenectomy.

Patients and methods: The records of all children who had splenectomy for hematological diseases at our hospital were reviewed for diagnosis, age at splenectomy, indication for splenectomy, sex, method of splenec- tomy, operative time, hospital stay, postoperative morbidity and mortality.

Results: A total of 315 children had splenectomy for various hematological diseases. There were 174 males and 141 females. The mean age was 7.6 years (1.8 – 13 years). Forty-seven (15%) had com- bined splenectomy and cholecystectomy. Eighty-six of them had laparoscopic splenectomy and 13 (15%) had laparoscopic splenectomy and cholecystectomy. SCD (239 sickle cell anemia and 22 sickle –beta-thalassemia) was the commonest indication for splenectomy (83%). Sixty- nine of those with SCD had laparoscopic splenectomy, 13 (18.8%) had combined laparoscopic sple- nectomy and cholecystectomy. When these were compared with a similar group of 88 children with SCD who had open splenectomy, laparoscopic splenectomy was superior in terms of faster recovery, shorter hospital stay, less postoperative complications and better cosmetic appearance but laparoscopic splenectomy took more operative time.

Conclusion: With good perioperative management, laparoscopic splenectomy is feasible and safe in children with SCD and can be done concomitantly with laparoscopic cholecystectomy. Currently, laparo- scopic splenectomy takes more operative time as these children tend to have large spleens with severe adhesions. Laparoscopic splenectomy however is superior to open splenectomy in terms of postoperative recovery, hospital stay, and cosmetic appearance.

Keywords: sickle cell anemia, splenectomy, cholecystectomy, complications, laparoscopic sple- nectomy, laparoscopic splenectomy and cholecystectomy

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