الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Laparoscopic approaches have gained strong momentum in last years. Indications and benefits of laparoscopy in pediatric are well established, so that laparoscopic approach had become the gold standard for splenectomy in pediatric age group.
Laparoscopic splenectomy (LS) has gained popularity as an option for benign hematological disorders in children and become an accepted alternative to the open procedure. This approach has several advantages: improved access to the operative field, early recovery, less postoperative pain, a lower complication rate and better cosmetic results. On the other hand, disadvantages include longer operative time increase cost and difficulty extracting large spleens.
The main aim of this study was to present our experience with laparoscopic splenctomy in children with hematological disorders and evaluate it as regards feasibility, safety, operative time, and perioperative complications in Pediatric Surgery Unit, Alexandria University Children’s Hospital between January 2022 and June 2023.
This is a prospective study of 37 consecutive children referred by a pediatric hematologist for splenectomy for hemolytic anemia. After receiving the mandatory vaccinations followed by abdominal ultrasound to measure splenic span and routine laboratory investigations, all patients underwent laparoscopic splenectomy. We have used Hem-o-lock to control splenic hilar vessels and spleens were extracted through Pfannenstiel incision. Operative time, intraoperative complications, and need for conversion were reported. Postoperative course, complications, and hospital stay were also recorded.
Patients were followed up for 3 months for development of complications and for evaluation of cosmetic appearance.
The age ranged from 4 to 14 years with a mean of 8.08 ± 3.19 years. 20 patients were males (54.1%) and 17 were females (45.9%). The most common primary disease was thalassemia, in 21 patients (56.8%), then spherocytosis, in 14 patients (37.8%), and only 2 cases with sickle-cell disease (5.4%). the splenic span ranged from 10.5 to 20 cm with a mean of 14.97 ± 2.22cm. Our operative time, counted until complete de-vascularization and separation of the spleen (excluding extraction time), ranged 60 from to 195 min with a mean of 99.71 ± 32.57 minutes. Only 2 out of 34 cases suffered intraoperative complications of a diaphragmatic injury and pancreatic tail injury. 2 cases suffered from postoperative ileus and managed medically. There was no mortality in the current series. Postoperative complications included extraction wound infection in 2 (5.9%) patients, which was controlled with local dressings and antibiotics and low-grade fever in 5 cases (14.7%).The average hospital stay was 2.41 ± 1.21 days.