Splenectomy indications and outcomes among children: a retrospective study from a tertiary care center in Saudi Arabia

Jood M. Alhejaili; Mohammad A. AlShawa; Atheer H. Alharbi; Saleh I. Alnassar

doi:10.18203/2349-2902.isj20262448

Authors

Jood M. Alhejaili Department of Pediatric Surgery, King Faisal Specialist Hospital and Research Center, Riyadh https://orcid.org/0009-0003-5099-842X
Mohammad A. AlShawa Department of Pediatric Surgery, Saudi German Hospital, Riyadh
Atheer H. Alharbi Department of Pediatric, King Faisal Specialist Hospital and Research Center, Riyadh
Saleh I. Alnassar Department of Pediatric Surgery, King Faisal Specialist Hospital and Research Center, Riyadh

DOI:

https://doi.org/10.18203/2349-2902.isj20262448

Keywords:

Blood transfusion, Hematological disorders, Laparoscopic, Spleen, Splenectomy

Abstract

Background: Splenectomy is a surgical procedure frequently performed on children and adolescents for several hematological indications. It is recognized as a safe and feasible procedure. However, post-splenectomy complications are recognized well in some cases. Experienced surgeons play a vital role in managing intra-operative and postoperative complications. Evaluate indications, outcomes and complications of splenectomy among children and to find out the indications for open splenectomy in the era of minimally invasive surgery in a tertiary care center.

Methods: A retrospective study was conducted among 71 children (0-14) years old who underwent a splenectomy at King Faisal Specialist hospital and Research Center (KFSHRC) in Riyadh, Saudi Arabia, from 2010-2019. The study is based on electronic medical records. Data analysis was carried out using the Excel analysis tool.

Results: In total, 71 pediatric participants were included in this study. 60 (84.5 %) of them underwent laparoscopic splenectomy (LS) and 11 (15%) open splenectomy (OS). For LS (35 males, 25 females), while in OS (Seven males, four females). The median age was seven years among the LS group and six among the OS group. The average hours of surgery were 2:13 Hours (LS) while 2:23 Hours (OS). The median hospital stay among LS was four and a half days and the OS group was six days. The most common immediate postoperative complication was fever.

Conclusions: Laparoscopic Splenectomy has become the standard of care. LS has advantages over OS, like earlier recovery and shorter hospital stay.

References

Mebius RE, Kraal G. Structure and function of the spleen. Nat Rev Immunol. 2005;5(8):606-16.

Luoto TT, Pakarinen MP, Koivusalo A. Long-term outcomes after pediatric splenectomy. Surgery. 2016;159(6):1583-90.

Utria AF, Goffredo P, Keck K, Shelton JS, Shilyansky J, Hassan I. Laparoscopic Splenectomy: Has It Become the Standard Surgical Approach in Pediatric Patients. J Surg Res. 2019;240:109-14.

Sinwar PD. Overwhelming post splenectomy infection syndrome-review study. Int J Surg. 2014;12(12):1314-6.

Standard of Care Guidelines for Thalassemia, children’s Hospital and Research Center Oakland. 2012.

Al-Salem AH. Indications and complications of splenectomy for children with sickle cell disease. J Pediatr Surg. 2006;41(11):1909-15.

Jastaniah W. Epidemiology of sickle cell disease in Saudi Arabia. Ann Saudi Med. 2011;31(3):289-93.

Qureshi FG, Ergun O, Sandulache VC, Nadler EP, Ford HR, Hackam DJ, et al. Laparoscopic splenectomy in children. JSLS. 2005;9(4):389-92.

Williams NS, Bulstrodrdecsk Connell PR. Bailey and Love’s short practice of surgery. 26th edition. II. Sebaceous Horn, London. 2013: 1087–96.

Akhtar IK, Ashraf M, Khalid IU, Hussain M. Surgical outcome of splenectomy in Thalassemia major in children. Pak J Med Sci. 2016;32(2):305-8.

Isa MM, Thayeb A, Yani A. Post total splenectomy outcome in thalassemia patients. Bali Medical J. 2018;8(3):764-7.

Pecorari L, Savelli A, Guna CD, Fracchia S, Borgna-Pignatti C. The Role of Splenectomy in Thalassemia Major. An Update. Acta Pediatrica Mediterranea. 2008;24:57–60.

Goers T, Panepinto J, Debaun M, Blinder M, Foglia R, Oldham KT, et al. Laparoscopic versus open abdominal surgery in children with sickle cell disease is associated with a shorter hospital stay. Pediatr Blood Cancer. 2008;50(3):603-6.

Tulman S, Holcomb GW 3rd, Karamanoukian HL, Reynhout J. Pediatric laparoscopic splenectomy. J Pediatr Surg. 1993;28(5):689-92.

Beanes S, Emil S, Kosi M, Applebaum H, Atkinson J. A comparison of laparoscopic versus open splenectomy in children. Am Surg. 1995;61(10):908-10.

Moores DC, McKee MA, Wang H, Fischer JD, Smith JW, Andrews HG. Pediatric laparoscopic splenectomy. J Pediatr Surg. 1995;30(8):1201-5.

Gigot JF, de Ville de Goyet J, Van Beers BE, Reding R, Etienne J, Jadoul P, et al. Laparoscopic splenectomy in adults and children: experience with 31 patients. Surgery. 1996;119(4):384-9.

Janu PG, Rogers DA, Lobe TE. A comparison of laparoscopic and traditional open splenectomy in childhood. J Pediatr Surg. 1996;31(1):109-13.

Farah RA, Rogers ZR, Thompson WR, Hicks BA, Guzzetta PC, Buchanan GR. Comparison of laparoscopic and open splenectomy in children with hematologic disorders. J Pediatr. 1997;(131):41-6.

Rescorla FJ, Breitfeld PP, West KW, Williams D, Engum SA, Grosfeld JL. A case-controlled comparison of open and laparoscopic splenectomy in children. Surgery. 1998;124(4):670-5.

Minkes RK, Lagzdins M, Langer JC. Laparoscopic versus open splenectomy in children. J Pediatr Surg. 2000;35(5):699-701.

Jackson HT, Kane TD. Advances in minimally invasive surgery in pediatric patients. Adv Pediatr. 2014;61(1):149-95.