Makansi M, Hutter M, Theilen TM, Fiegel HC, Rolle U, Gfroerer S. Comparison of perioperative outcomes between laparoscopic and open partial splenectomy in children and adolescents. World J Gastrointest Surg 2021; 13(9): 979-987 [PMID: 34621474 DOI: 10.4240/wjgs.v13.i9.979]
Corresponding Author of This Article
Stefan Gfroerer, MD, PhD, Director, Department of Pediatric Surgery and Pediatric Urology, Helios Clinic Berlin-Buch, Schwanebecker Chaussee 50, Berlin 13125, Germany. stefan.gfroerer@helios-gesundheit.de
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2021; 13(9): 979-987 Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.979
Comparison of perioperative outcomes between laparoscopic and open partial splenectomy in children and adolescents
Mohamed Makansi, Martin Hutter, Till-Martin Theilen, Henning C Fiegel, Udo Rolle, Stefan Gfroerer
Mohamed Makansi, Martin Hutter, Till-Martin Theilen, Henning C Fiegel, Udo Rolle, Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Frankfurt am Main 60590, Germany
Stefan Gfroerer, Department of Pediatric Surgery and Pediatric Urology, Helios Clinic Berlin-Buch, Berlin 13125, Germany
Author contributions: Makansi M performed the acquisition, analysis and interpretation of data, drafted the paper and gave final approval of the version of the article to be published; Hutter M contributed substantially to the conception and design of the study, made critical revisions to important content of the manuscript and gave final approval of the version to be published; Theilen TM, Fiegel HC and Rolle U contributed substantially to analysis and interpretation of data, provided critical revisions related to important intellectual content of the manuscript and gave final approval of the manuscript version to be published; Gfroerer S designed the research study and provided substantial contribution to acquisition, analysis and interpretation of data, contributed substantially to drafting the manuscript and gave final approval of the version to be published.
Institutional review board statement: The study protocols were reviewed and approved by the Ethics Committee of the University Hospital Frankfurt (339/18).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written informed consent.
Conflict-of-interest statement: Makansi M, Hutter M and Drs. Gfroerer S, Fiegel HC, Theilen TM and Rolle U have no conflicts of interest or financial ties to disclose in relation to this manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stefan Gfroerer, MD, PhD, Director, Department of Pediatric Surgery and Pediatric Urology, Helios Clinic Berlin-Buch, Schwanebecker Chaussee 50, Berlin 13125, Germany. stefan.gfroerer@helios-gesundheit.de
Received: February 9, 2021 Peer-review started: February 9, 2021 First decision: March 30, 2021 Revised: April 10, 2021 Accepted: July 29, 2021 Article in press: July 29, 2021 Published online: September 27, 2021 Processing time: 220 Days and 19.1 Hours
Abstract
BACKGROUND
In order to avoid consequences of total splenectomy, partial splenectomy (PS) is increasingly reported. The purpose of this study was to compare perioperative outcomes of laparoscopic PS (LPS) and open PS (OPS) in children and adolescents.
AIM
To compare perioperative outcomes of patients with LPS and OPS.
METHODS
After institutional review board approval, a total of 26 patients that underwent LPS or OPS between January 2008 and July 2018 were identified from the database of our tertiary referral center. In total, 10 patients had LPS, and 16 patients underwent OPS. Blood loss was calculated by Mercuriali’s formula. Pain scores, analgesic requirements and complications were assessed. The Wilcoxon rank sum test was used for comparison. To compare categorical variables, Fisher’s exact test was applied.
RESULTS
LPS was performed in 10 patients; 16 patients had OPS. Demographics (except for body mass index and duration of follow-up), indicating primary disease, preoperative spleen size and postoperative spleen volume, perioperative hematological parameters, postoperative pain scores, analgesic requirements, adverse events according to the Clavien-Dindo classification and the comprehensive complication index, median time from operation to initiation of feeds, median time from operation to full feeds, median time from operation to mobilization and median length of hospital stay did not differ between LPS and OPS. Median (range) operative time (min) was longer in LPS compared to the OPS group [185 (135-298) vs 144 (112-270), respectively; P = 0.048]. Calculated perioperative blood loss (mL of red blood cell count) was higher in the LPS group compared to OPS [87 (-45-777) vs -37 (-114-553), respectively; P = 0.039].
CONCLUSION
This is the first study that compared outcomes of LPS and OPS. Both operative approaches had comparable perioperative outcomes. LPS appears to be a viable alternative to OPS.
Core Tip: In this retrospective study, perioperative outcomes of children and adolescents that underwent laparoscopic or open partial splenectomy were analyzed. Postoperative outcomes including initiation of feeds and mobilization, adverse events assessed according to the Clavien-Dindo classification and the comprehensive complication index, postoperative pain scores and analgesic requirements were similar between both groups. Operative time and intraoperative blood loss were higher in the laparoscopic group. Results indicate that laparoscopic partial splenectomy is a safe alternative to open partial splenectomy. Future research needs to focus on a larger patient cohort and a prospective study design.
