Italian multicentric survey on laparoscopic spleen surgery in thepediatric population

AbstractBackground: Some technical aspects of laparoscopicspleen surgery still are debated, although efforts havebeen made to standardize them. The position of thepatient, the approach to the spleen, vessel identificationand division, and spleen extraction can vary from centerto center.Methods: This retrospective muticentric study led by theSocieta` Italiana di Videochirurgia Infantile (SIVI)examined indications, surgical details, and complicationsof laparoscopic spleen surgery in the pediatricpopulation during a 5-year period.Results: The study period from January 1999 toDecember 2003 (5 years) involved nine centers and included85 patients with a mean age of 10 years (range, 2–17 years). Hypersplenism or severe hemolysis in cases ofhematologic disorders represented the most importantindications. More than 90% of the patients underwenttotal laparoscopic splenectomy. Specific technical detailsfrom each center were collected. Intraoperative complicationsoccurred in 19% of the patients (hemorrhage in8% and technical problems in 14%), and 6% of the patientsrequired conversion to the open approach. Nodeaths occurred, and no reoperations were required.Postoperative complications were experienced by 2% ofthe patients.Conclusion: Laparoscopic spleen surgery is safe, reliable,and effective in the pediatric population. On the basis ofthe results, some technical details for laparoscopicspleen surgery can be suggested. The patient is preferablykept supine or lateral, approaching the spleenanteriorly. Moreover, the ilar vessels should be identifiedselectively and individually, with initial artery divisionperformed to achieve spleen shrinking. Anyhemostatic device proved to be effective in experiencedhands. Once freed, the spleen is preferably extracted viaa suprapubic cosmetic transverse incision (faster, easier,and safer), although a bag can be used. Finally, the sizeof the spleen does not represent a contraindication for atrained and experienced surgeon. Nevertheless, thisparameter must be considered