Comparison of perioperative outcomes between laparoscopic and open partial splenectomy in children and adolescents

Table 1 Demographic data for 26 patients undergoing laparoscopic partial splenectomy or open partial splenectomy

	Laparoscopic, n = 10	Open, n = 16	P value
Gender (male:female)	2:8	7:9	0.399
Age at operation (yr)	13.1 (7.7-20.3)	10.7 (5.0-18.2)	0.220
Weight at operation (kg)	50.5 (25.0-70.0)	32.6 (18.0-70.0)	0.120
Height at operation (m)	1.54 (1.28-1.67)	1.41 (1.10-1.85)	0.316
BMI at operation (kg/m2)	21.30 (14.92-25.71)	16.58 (12.71-24.22)	0.036
Indicating primary disease			0.292
Hereditary spherocytosis (%)	9 (90)	14 (88)
DiGeorge syndrome (%)	0 (0)	2 (13)
Splenic cyst (%)	1 (10)	0 (0)
Duration of follow-up (yr)	4.1 (2.1-5.2)	6.6 (4.4-11.4)	< 0.001

Data are median (range) or frequency (%). BMI: Body mass index.

Table 2 Spleen characteristics

	Laparoscopic, n = 10	Open, n = 16	P value
Preoperative longitudinal spleen diameter (cm)	15.8 (12.2-29.0)	14.0 (9.9-28.9)	0.523
Postoperative spleen volume (cm3)	24 (16-48)	31 (11-210)	0.244
Total splenectomy leaving the accessory spleen (%)	2 (20)	0 (0)	0.138
Splenic US visibility in follow-up sonography (%)	4 (57) —n = 7	11 (79) —n = 14	0.354

Data are median (range) or frequency (%). US: Ultrasonography.

Table 3 Operative variables

	Laparoscopic, n = 10	Open, n = 16	P value
Operative time (min)	185 (135-298)	144 (112-270)	0.048
Simultaneous cholecystectomy (%)	6 (60)	13 (81)	0.369
Primary (first PS) operation (%)	10 (100)	15 (94)	1
Secondary (redo PS) operation	0	1 (6)
Conversion to open (%)	1 (10)

Data are median (range) or frequency (%). PS: Partial splenectomy.

Table 4 Postoperative outcomes

	Laparoscopic, n = 10	Open, n = 16	P value
Time from OP to initiation of feeds (h)	37 (4-62)	28 (16-63)	0.580
Time from OP to full feeds (d)	3.5 (2.0-7.0)	4.0 (3.0-6.0)	0.313
Time from OP to mobilization (h)	46 (22-92)	47 (19-98)	0.812
Length of postoperative hospital stay (d)	5 (3-8)	5 (3-8)	0.602
Morbidity (Clavien-Dindo grade I-V) (%)	3 (30)	9 (56)	0.248
Minor morbidity (Clavien-Dindo grade I-II) (%)	3 (30)	8 (50)	0.428
Major morbidity (Clavien-Dindo grade III-V) (%)	0 (0)	2 (13)	0.508
Comprehensive complication index	0 (0-24.20)	8.66 (0-39.70)	0.387

Data are median (range) or frequency (%). OP: Operation.

Table 5 Individual profile of postoperative adverse events graded according to Clavien-Dindo and with calculated comprehensive complication index

	Postoperative adverse events	Clavien-Dindo grade	CCI
Laparoscopic
Patient 17	Urticaria	II	20.9
Patient 18	Pruritus	II	20.9
Patient 24	Pleural effusion	I
	External genital edema	I
	Blood transfusion	II	24.2
Open
Patient 1	Lid edema	I	8.7
Patient 3	Urticaria	II	20.9
Patient 4	Pleural effusion	I	8.7
Patient 6	Pleural effusion	I	8.7
Patient 7	Wound dehiscence	I	8.7
Patient 9	Exanthema	II	20.9
Patient 11	Urine retention. bladder catheterization	IIIa	26.2
Patient 13	Wound infection	II
	Redo partial splenectomy	IIIb	39.7
Patient 20	Pleural effusion	I	8.7

CCI: Comprehensive complication index.

Table 6 Perioperative hematological variables

	Laparoscopic, n = 10	Open, n = 16	P value
Latest hematocrit prior to operation (%)	31.6 (18.7-33.4)	28.1 (24.1-35.7)	0.633
Latest hemoglobin prior to operation (g/L)	114 (65-122)	97 (78-133)	0.221
Lowest hematocrit postoperative (%)	28.0 (26.0-31.0)	30.0 (23.0-35.0)	0.131
Lowest hemoglobin postoperative (g/L)	93 (79-104)	99 (67-126)	0.118
Estimated blood loss (mL of RBC)	87 (-45-777)	-37 (-114-553)	0.039
Patients receiving intra- or postoperative RBC (%)	2 (20)	1 (6)	0.538
Patients receiving intra- or postoperative FFP and TC (%)	0 (0)	2 (13)	0.508

Data are median (range) or frequency (%). RBC: Red blood cell count; FFP: Fresh frozen plasma; TC: Thrombocyte concentrate.

Table 7 Pain assessment and analgesics

	Laparoscopic, n = 10	Open, n = 13	P value
Pain assessment1 (0-10 NRS)			0.1522
Day 1	4 (2-6)	4 (2-9)
Day 2	2 (0-4)	4 (1-7)
Day 3	1.0 (0-2.5)	2.0 (1.0-4.0)
Day 4	0 (0-1)	1 (0-2)
Day 5	0 (0-3)	0 (0-5)
Day 6	0 (0-4)	0 (0-0)
Day 7	0 (0-0)	0 (0-0)
Non-opioids — cumulative doses (mg/kg body weight)
Day 1	33.5 (10.0-48.4)	37.7 (19.2-50.0)
Day 2	35.3 (10.0-60.5)	31.6 (10.0-68.2)
Day 3	22.5 (0-37.0)	30.3 (9.3-54.6)
Day 4	5.0 (0-36.3)	18.2 (0-39.9)
Day 5	0 (0-36.3)	0 (0-18.8)
Day 6	0 (0-65.3)	0 (0-0)
Day 7	0 (0-36.3)	0 (0-0)
Overall dose	113.0 (20.1-308.0)	134.8 (50.5-172.7)	0.232
Opioids — cumulative doses (mg/kg body weight)
Day 1	0.44 (0-0.69)	0.32 (0-0.51)
Day 2	0.42 (0-0.93)	0.28 (0-0.55)
Day 3	0.25 (0-0.71)	0.09 (0-0.55)
Day 4	0.08 (0-0.65)	0 (0-0.31)
Day 5	0 (0-0.53)	0 (0-0.08)
Day 6	0 (0-0.31)	0 (0-0)
Day 7	0 (0-0.26)	0 (0-0)
Overall dose	1.06 (0.09-3.58)	0.72 (0-1.75)	0.343

¹Median of all Numerical Rating Scale scores within 24 h.

²Comparison whether the pain scores of each day differed between the groups over time. Data are median (range) or frequency (%). Three patients in the open group were excluded from comparison due to peridural anesthesia treatment. NRS: Numerical Rating Scale.