Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.979
Peer-review started: February 9, 2021
First decision: March 30, 2021
Revised: April 10, 2021
Accepted: July 29, 2021
Article in press: July 29, 2021
Published online: September 27, 2021
In order to avoid consequences of total splenectomy, partial splenectomy (PS) is increasingly reported. The purpose of this study was to compare perioperative outcomes of laparoscopic PS (LPS) and open PS (OPS) in children and adole
To compare perioperative outcomes of patients with LPS and OPS.
After institutional review board approval, a total of 26 patients that underwent LPS or OPS between January 2008 and July 2018 were identified from the database of our tertiary referral center. In total, 10 patients had LPS, and 16 patients underwent OPS. Blood loss was calculated by Mercuriali’s formula. Pain scores, analgesic requirements and complications were assessed. The Wilcoxon rank sum test was used for comparison. To compare categorical variables, Fisher’s exact test was applied.
LPS was performed in 10 patients; 16 patients had OPS. Demographics (except for body mass index and duration of follow-up), indicating primary disease, preoperative spleen size and postoperative spleen volume, perioperative hematological parameters, postoperative pain scores, analgesic requirements, adverse events according to the Clavien-Dindo classification and the comprehensive complication index, median time from operation to initiation of feeds, median time from operation to full feeds, median time from operation to mobilization and median length of hospital stay did not differ between LPS and OPS. Median (range) operative time (min) was longer in LPS compared to the OPS group [185 (135-298) vs 144 (112-270), respectively; P = 0.048]. Calculated perioperative blood loss (mL of red blood cell count) was higher in the LPS group compared to OPS [87 (-45-777) vs -37 (-114-553), respectively; P = 0.039].
This is the first study that compared outcomes of LPS and OPS. Both operative approaches had comparable perioperative outcomes. LPS appears to be a viable alternative to OPS.
Core Tip: In this retrospective study, perioperative outcomes of children and adolescents that underwent laparoscopic or open partial splenectomy were analyzed. Postoperative outcomes including initiation of feeds and mobilization, adverse events assessed according to the Clavien-Dindo classification and the comprehensive complication index, postoperative pain scores and analgesic requirements were similar between both groups. Operative time and intraoperative blood loss were higher in the laparoscopic group. Results indicate that laparoscopic partial splenectomy is a safe alternative to open partial splenectomy. Future research needs to focus on a larger patient cohort and a prospective study design.