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©The Author(s) 2021.
World J Gastrointest Surg. Sep 27, 2021; 13(9): 979-987
Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.979
Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.979
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 |
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 |
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) |
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 |
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 |
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 |
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 |
- Citation: 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
- URL: https://www.wjgnet.com/1948-9366/full/v13/i9/979.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v13.i9.979