Abstract
Purpose
We conducted a systematic review and meta-analysis to compare the clinical outcomes between laparoscopic splenectomy and the traditional open splenectomy in children.
Methods
Literature searches were conducted to identify studies having compared the laparoscopic splenectomy (LS) and open splenectomy (OS) for children. Parameters such as operative time, blood loss, length of postoperative stay, the removal of accessory spleens and postoperative complications including postoperative high fever, acute chest syndrome (ACS), and ileus were pooled and compared by meta-analysis.
Results
Among the 922 pediatric participants included in the 10 studies, 508 had received LS and 414 OS. There were shorter length of hospital stays, less blood loss, and longer operative times with the LS approach compared with OS. However, no significant difference was found between LS and OS in the secondary outcome, such as the removal of accessory spleens or postoperative complications including postoperative high fever, ACS, and ileus.
Conclusion
LS is a feasible, safe, and effective surgical procedure alternative to OS for pediatric patients. Compared with OS, LS has the advantage of shorter hospital stay and less blood loss. Besides, total postoperative complications may be slightly lower in LS. We conclude that LS should be considered an acceptable option for children.
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References
Marble ICR, Deckers PJ, Kern KA (1995) Changing role of splenectomy for hematologic disease. J Surg Oncol 52:169–171
Winslow ER, Brunt LM (2003) Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery 134(4):647–653
Tulman S, Holcomb GW, Karamanoukian HL, Reynhout J (1993) Laparoscopic splenectomy. J Pediatr Surg 28:689–692
Kathkouda N, Hurtwitz MB, Rivera RT et al (1998) Laparoscopic splenectomy: outcome and efficacy in 103 consecutive cases. Ann Surg 228:568–578
Targarona EM, Espert JJ, Balague C et al (1998) Residual splenic functions after laparoscopic splenectomy: a clinical concern. Arch Surg 133:56–60
Gigot JF, Jamar F, Ferrant A et al (1998) Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy: a shortcoming of the laparoscopic approach in hematologic diseases. Surg Endosc 12:101–106
Zhu J, Ye H, Wang Y et al (2011) Laparoscopic versus open pediatric splenectomy for massive splenomegaly. Surg Innov 18(4):349–353
Qureshi FG, Ergun O, Sandulache VC et al (2005) Laparoscopic splenectomy in children. JSLS 9:389–392
Alwabari A, Parida L, Al-Salem AH (2009) Laparoscopic splenectomy and/or cholecystectomy for children with sickle cell disease. Pediatr Surg Int 25:417–421
Rescorla FJ, Breitfeld PP, West KW et al (1998) A case-controlled comparison of open and laparoscopic splenectomy in children. Surgery 124:670–675
Lesher AP, Kalpatthi R, Glenn JB et al (2009) Outcome of splenectomy in children younger than 4 years with sickle cell disease. J Pediatr Surg 44(6):1134–1138
Hassan ME, Al Ali K (2014) Massive splenomegaly in children: laparoscopic versus open splenectomy. JSLS 18(3):1–5
Kühne T, Blanchette V, Buchanan GR et al (2007) Splenectomy in children with idiopathic thrombocytopenic purpura: a prospective study of 134 children from the Intercontinental Childhood ITP Study Group. Pediatr Blood Cancer 49(6):829–834
Wood JH, Partrick DA, Hays T et al (2011) Contemporary pediatric splenectomy: continuing controversies. Pediatr Surg Int 27(11):1165–1171
Goers T, Panepinto J, DeBaun M et al (2008) Laparoscopic versus open abdominal surgery in children with sickle cell disease is associated with a shorter hospital stay. Pediatr Blood Cancer 50:603–606
Farah RA, Rogers ZR, Thompson WR et al (1997) Comparison of laparoscopic and open splenectomy in children with hematologic disorders. J Pediatr 131:41–46
Rescorla FJ, Engum SA, West KW, Tres Scherer LR 3rd, Rouse TM, Grosfeld JL (2002) Laparoscopic splenectomy has become the gold standard in children. Am Surg 68(3):297–301
Reddy VS, Phan HH, O’Neill JA et al (2001) Laparoscopic versus open splenectomy in the pediatric population: a contemporary single-center experience. Am Surg 67(9):859–863
Habermalz B, Sauerland S, Decker G et al (2008) Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 22:821–848
Stanek A, Stefaniak T, Makarewicz W et al (2005) Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients. Langenbecks Arch Surg 390:47–51
Sampath S, Meneghetti AT, MacFarlane JK et al (2007) An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Am J Surg 193:580–584
Murawski M, Patkowski D, Korlacki W et al (2008) Laparoscopic splenectomy in children-a multicenter experience. J Pediatr Surg 43(5):951–954
Al-Mulhim AS (2012) Laparoscopic splenectomy for massive splenomegaly in benign hematological diseases. Surg Endosc 26(11):3186–3189
Acknowledgments
The manuscript had been proofread by Professor Xin-He Lai, Institute of Translational Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Feng, S., Qiu, Y., Li, X. et al. Laparoscopic versus open splenectomy in children: a systematic review and meta-analysis. Pediatr Surg Int 32, 253–259 (2016). https://doi.org/10.1007/s00383-015-3845-2
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DOI: https://doi.org/10.1007/s00383-015-3845-2