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DOI: 10.1055/s-0036-1593979
Laparoscopic Splenectomy in Children: A Modified Technique with Joint Sealing of Segmental Splenic Arteries and Veins Favorably Compared with the Classic Technique
Publication History
15 May 2016
20 September 2016
Publication Date:
15 November 2016 (online)
![](https://www.thieme-connect.de/media/ejps/201701/lookinside/thumbnails/10-1055-s-0036-1593979_163763oa-1.jpg)
Abstract
Introduction Splenectomy in children is nowadays widely performed by laparoscopy, the major risk being operative hemorrhage. We hereby compare the results of two different techniques of vascular control.
Materials and Methods We retrospectively reviewed all patients undergoing a laparoscopic splenectomy (LS) for hematologic disease at a single institution from 2004 to 2013. LS was performed by a lateral approach. The 10-mm optic port was placed in the umbilicus and two 5-mm working ports were placed in the left lower quadrant and in the right upper quadrant near the midline.
An additional port was added in the epigastrium if needed. The classic technique (CT) consisted in the separate sealing and section of the splenic artery and vein above the pancreas tail. The modified technique (MT) consisted in the dissection of each segmental splenic vessel, at the lower, middle, and upper parts of the spleen. They were then divided without individualizing the artery from the vein.
Results Total 69 patients were operated on at a mean age of 7.8 ± 0.6 years, 30 by CT and 39 by MT. In 20 patients (6 CT, 14 MT) a cholecystectomy was associated. The operative time, length of hospitalization, and number of postoperative complications for CT/MT were respectively 139/117 mn (p = 0.04), 3.8/3.0 days (p = 0.01), 12/3 (p = 0.002). An additional port was less needed with MT (p = 0.03).
Conclusions The joint sealing of segmental splenic artery and vein appeared safe, efficient and quicker for LS, with no increased risk of operative bleeding and postoperative complications.
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References
- 1 Beanes S, Emil S, Kosi M, Applebaum H, Atkinson J. A comparison of laparoscopic versus open splenectomy in children. Am Surg 1995; 61 (10) 908-910
- 2 Minkes RK, Lagzdins M, Langer JC. Laparoscopic versus open splenectomy in children. J Pediatr Surg 2000; 35 (5) 699-701
- 3 Reddy VS, Phan HH, O'Neill JA , et al. Laparoscopic versus open splenectomy in the pediatric population: a contemporary single-center experience. Am Surg 2001; 67 (9) 859-863 , discussion 863–864
- 4 Tulman S, Holcomb III GW, Karamanoukian HL, Reynhout J. Pediatric laparoscopic splenectomy. J Pediatr Surg 1993; 28 (5) 689-692
- 5 Esposito C, Schaarschmidt K, Settimi A, Montupet P. Experience with laparoscopic splenectomy. J Pediatr Surg 2001; 36 (2) 309-311
- 6 Rescorla FJ, West KW, Engum SA, Grosfeld JL. Laparoscopic splenic procedures in children: experience in 231 children. Ann Surg 2007; 246 (4) 683-687 , discussion 687–688
- 7 Vargün R, Göllü G, Fitöz S, Yagmurlu A. En-bloc stapling of the splenic hilum in laparoscopic splenectomy. Minim Invasive Ther Allied Technol 2007; 16 (6) 360-362
- 8 Gelmini R, Romano F, Quaranta N , et al. Sutureless and stapleless laparoscopic splenectomy using radiofrequency: LigaSure device. Surg Endosc 2006; 20 (6) 991-994
- 9 Kennedy JS, Stranahan PL, Taylor KD, Chandler JG. High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc 1998; 12 (6) 876-878
- 10 Brothers TE, Stanley JC, Zelenock GB. Splenic arteriovenous fistula. Int Surg 1995; 80 (2) 189-194
- 11 Crusco F, Antoniella A, Puligheddu C, Fabbri AZ, Giovagnoni A. Post-operative splenic arteriovenous fistula detected with 16-multidetector computed tomography. Br J Radiol 2007; 80 (957) e216-e218
- 12 Buchholz RR. Arteriovenous fistula of the splenic vessels; report of a case following splenectomy. Ann Surg 1959; 149 (4) 590-592
- 13 Ji B, Liu Y, Zhang P, Wang Y, Wang G. A two-step control of secondary splenic pedicles using LigaSure during laparoscopic splenectomy. Int J Med Sci 2012; 9 (9) 743-747
- 14 Podevin G, Victor A, De Napoli S, Heloury Y, Leclair MD. Laparoscopic splenectomy: comparison between anterior and lateral approaches. J Laparoendosc Adv Surg Tech A 2011; 21 (9) 865-868
- 15 Carbonell AM, Joels CS, Kercher KW, Matthews BD, Sing RF, Heniford BT. A comparison of laparoscopic bipolar vessel sealing devices in the hemostasis of small-, medium-, and large-sized arteries. J Laparoendosc Adv Surg Tech A 2003; 13 (6) 377-380
- 16 Qu Y, Ren S, Li C, Qian S, Liu P. Management of postoperative complications following splenectomy. Int Surg 2013; 98 (1) 55-60
- 17 Lacombe M, Hannoun L. [Arteriovenous fistula of splenic vessels after splenectomy]. J Chir (Paris) 1984; 121 (3) 159-162
- 18 Kouba E, Smith AM, Derksen JE, Gunn K, Wallen E, Pruthi RS. Efficacy and safety of en bloc ligation of renal hilum during laparoscopic nephrectomy. Urology 2007; 69 (2) 226-229
- 19 Di Lecce F, Viganò P, Busani M , et al. [Splenic arterio-venous fistula and portal hypertension. A case report with review of the literature]. G Chir 2006; 27 (8-9): 328-330
- 20 Gartside R, Gamelli RL. Splenic arteriovenous fistula. J Trauma 1987; 27 (6) 671-673
- 21 Soyer T, Ciftci AO, Tanyel FC, Senocak ME, Büyükpamukçu N. Portal vein thrombosis after splenectomy in pediatric hematologic disease: risk factors, clinical features, and outcome. J Pediatr Surg 2006; 41 (11) 1899-1902
- 22 Stamou KM, Toutouzas KG, Kekis PB , et al. Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins. Arch Surg 2006; 141 (7) 663-669
- 23 Sarioğlu A, Tanyel FC, Ariyürek M, Balkanci F, Hiçsönmez A. Aneurysmatic arteriovenous fistula complicating splenic injury. Eur J Pediatr Surg 1996; 6 (3) 183-185
- 24 Aydin C, Kayaalp C, Olmez A, Tatli F, Kirimlioglu V. Laparoscopic splenectomy with a vessel sealing device. Minim Invasive Ther Allied Technol 2008; 17 (5) 308-312
- 25 Machado NO, Al Kindy N, Chopra PJ. Laparoscopic splenectomy using LigaSure. JSLS 2010; 14 (4) 547-552
- 26 Murawski M, Patkowski D, Korlacki W , et al. Laparoscopic splenectomy in children—a multicenter experience. J Pediatr Surg 2008; 43 (5) 951-954