RESUMEN
INTRODUCTION: Partial splenectomy (PS) in children is a surgical option in haematological diseases and focal splenic tumours. The aim of this study was to describe the feasibility and the results of laparoscopic partial splenectomy in children in these two indications by a multicentric retrospective study. METHODS: The authors reviewed the files of all children who underwent laparoscopic PS between March 2002 and September 2006 in two paediatric surgical centers. The data of 11 children were collected and included clinical presentation, age, gender, radiographic examinations, surgical procedure, need for blood transfusion and early complications. RESULTS: From March 2002 to September 2006, laparoscopic PS had been performed on 11 children (6 boys, 5 girls) aged 23 months to 11 years (mean 7, 9). Four children had splenic focal tumours and seven had haematological diseases: six hereditary spherocytosis (HS) and one hemoglobinosis E. During the surgical procedure for haematological diseases 75-80% of the splenic tissue was removed. When PS was performed for focal splenic tumours, the splenic remnant was around 70%. No preoperative complications occurred (no bleeding, no diaphragmatic injury). Neither preoperative nor conversion was necessary. One postoperative complication occurred (left pleural effusion) but required no further treatment. The mean hospital stay was 7.7 days (range from 3 days to 10 days). No infectious postoperative complications occurred; the mean follow up was 21.1 months (range 3-52 months). CONCLUSION: Laparoscopic partial splenectomy is feasible and safe in children with hypersplenism or focal splenic tumours. Partial splenectomy is a good way to prevent postsplenectomy infections by preservation of the immune role of spleen in children with haematological diseases. This technique performed for focal splenic tumours allows the surgeon to choose the size of the splenic remnant.
Asunto(s)
Neoplasias Hematológicas/complicaciones , Laparoscopía/métodos , Esplenectomía/métodos , Enfermedades del Bazo/cirugía , Factores de Edad , Niño , Preescolar , Quiste Epidérmico/complicaciones , Quiste Epidérmico/patología , Femenino , Estudios de Seguimiento , Hemangioma/complicaciones , Hemangioma/patología , Neoplasias Hematológicas/patología , Humanos , Lactante , Laparoscopía/efectos adversos , Tiempo de Internación , Masculino , Estadificación de Neoplasias , Dolor Postoperatorio , Complicaciones Posoperatorias , Estudios Retrospectivos , Medición de Riesgo , Esferocitosis Hereditaria/complicaciones , Esferocitosis Hereditaria/patología , Enfermedades del Bazo/etiologíaRESUMEN
We present a case of acute volvulus of a wandering spleen in a 5-year-old girl that was diagnosed preoperatively by computed tomography scan and which we treated with a laparoscopic splenopexy on an emergent basis.