Single-incision laparoscopic splenectomy in children with massive splenomegaly: A prospective, monocentric pilot study

Congjun Wang; Cheng Su; Chao Chen; Xianming Tang; Hong Wang; Wei Li; Yanqiang Li; Qiang Liu; Peng Chen; Yong Li; Yige Luo

doi:10.3389/fped.2022.1097416

Single-incision laparoscopic splenectomy in children with massive splenomegaly: A prospective, monocentric pilot study

Front Pediatr. 2023 Jan 10:10:1097416. doi: 10.3389/fped.2022.1097416. eCollection 2022.

Authors

Congjun Wang¹, Cheng Su¹, Chao Chen¹, Xianming Tang¹, Hong Wang¹, Wei Li¹, Yanqiang Li¹, Qiang Liu¹, Peng Chen¹, Yong Li¹, Yige Luo¹

Affiliation

¹ Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China.

Abstract

Background: Single-incision laparoscopic splenectomy (SILS) remains a challenging procedure because of the technical difficulty. In this prospective study, we aimed to evaluate the efficacy and safety of SILS in children with massive splenomegaly.

Methods: Pediatric patients with massive splenomegaly were recruited for SILS in a university-affiliated hospital. The data on patient demographics, clinical features, operative variables, and perioperative outcomes were collected prospectively and analyzed. According to the different surgical instruments, the patients were randomly assigned into two groups: the SILS with straight surgical instrument (SILS-S) group and the SILS with curved surgical instrument (SILS-C) group. A two-group comparative analysis was conducted using perioperative data from the different surgical instrumentation systems.

Results: A total of 120 patients were included, of which 103 patients (success group, 85.83%) had complete SILS, the other 17 (failure group, 14.17%) patients were converted to open (n = 4, 3.33%) or multi-incision laparoscopic surgery (n = 13, 10.83%). The major cause for surgical failure is uncontrollable bleeding (n = 14, 82.35%), and age, height, and weight were the risk factors for failure of SILS, but none of the parameters were independent risk factors. The blood loss in the success group was less than that in the failure group, but no significant differences in other operative and outcome indicators. For SILS, the mean (±SD) operative time was 188 (±48.70) minutes, the median intraoperative blood loss (min, max) was 20 (5, 290) ml, the mean (±SD) time of first anal exhaust was 23.9 (±7.73) hours, and the mean (±SD) postoperative hospital stay was 4.72 (±1.03) days. The median pain score was 3 on 1 day, and 1 on 3 days after the operation. Postoperative complications were identified in 8 (7.77%) cases. However, there were no peri-operative deaths in this series. The SILS-C group had a significantly shorter operation time than the SILS-S group (mean ± SD, 172 ± 44.21 vs. 205 ± 47.90 min). There were no significant differences between the two groups in other perioperative data (P < 0.05).

Conclusion: SILS is a safe and feasible treatment in pediatric patients with massive splenomegaly, and curved surgical instrumentation has contributed to developing surgical manipulation.

Keywords: pediatric surgery; single-incision laparoscopy; splenectomy; splenomegaly; surgical outcomes.

Grants and funding

This work was supported by The Basic Ability Enhancement Program for Young and Middle-aged Teachers of Guangxi (grant no. 2020KY03022 and 2021KY0084), the Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project (grant no. S2019104), and Self-funded Research Projects of Guangxi Zhuang Autonomous Region Health Department (grant no. S20180943), Guangxi Natural Science Foundation (Grant no. 2021JJA140870), and National Natural Science Foundation of China (Grant no. 82060129).