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- Title
A Comparison of Single-Incision Versus Multiport Laparoscopic Splenectomy in Children.
- Authors
Traynor, Michael D.; Camazine, Maraya N.; Potter, D. Dean; Moir, Christopher R.; Klinkner, Denise B.; Ishitani, Michael B.
- Abstract
Background: Although single-incision endoscopic splenectomy (SIES-Sp) has been shown to be feasible and safe, few have compared the SIES-Sp with multiport laparoscopic splenectomy (MPLS). The purpose of this study was to compare the two techniques in children undergoing total splenectomy. Materials and Methods: We reviewed all children (age <18 years) who underwent minimally invasive total splenectomy at a single tertiary referral center from January 1, 2000 to January 1, 2019. The primary outcome was complication rate 30 days after discharge defined by maximum Clavien-Dindo score. Secondary outcomes included conversion, operative time, hospital length of stay, postoperative pain scores, and readmission within 30 days of discharge. SIES-Sp and MPLS were compared using univariate analysis. Results: Of 48 children undergoing laparoscopic total splenectomy, 60% (n = 29) were SIES-Sp and 40% (n = 19) were MPLS. Subjects were 48% female (n = 23). Common diagnoses were idiopathic thrombocytopenic purpura (33% [n = 16]), hereditary spherocytosis (29% [n = 14]), and other congenital hemolytic anemias (23% [n = 11]). There were no differences in age, gender, or diagnosis between groups (all P > .05). One in three cases involved additional procedures. Spleens were smaller in both greatest dimension (13.0 cm versus 16.4 cm) and weight (156.5 g versus 240.0 g) in SIES-Sp compared with MPLS patients (both P < .05). Readmission and reoperation rates were similar (both P > .05). Complications occurred in 7% (n = 2) of SIES-Sp and in 11% (n = 2) of MPLS patients (P > .99). Severe complications included: cardiac arrest in 1 SIES-Sp patient and bleeding requiring reoperation in 1 MPLS patient. Conclusion: SIES-Sp is a safe alternative to the traditional MPLS for children. Additional procedures do not preclude a less invasive approach, but larger spleens may present a challenge.
- Subjects
SPLENECTOMY; IDIOPATHIC thrombocytopenic purpura; LAPAROSCOPIC surgery; LENGTH of stay in hospitals; DIAGNOSIS; HEMOLYTIC anemia; RESEARCH; RESEARCH methodology; SURGICAL complications; RETROSPECTIVE studies; EVALUATION research; COMPARATIVE studies; LAPAROSCOPY; REOPERATION
- Publication
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2021, Vol 31, Issue 1, p106
- ISSN
1092-6429
- Publication type
journal article
- DOI
10.1089/lap.2020.0392