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Pediatric Surgery International
Published in: Pediatric Surgery International 3/2020

01-03-2020 | Splenectomy | Original Article

Laparoscopic ligation of splenic vessels for the treatment of hereditary spherocytosis in children

Authors: Jin-Shan Zhang, Long Li

Published in: Pediatric Surgery International | Issue 3/2020

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Abstract

Background

Total splenectomy is the most effective surgical treatment for hereditary spherocytosis (HS). Nevertheless, post-splenectomy sepsis and hypoimmunity can pose a great risk to children. Some alternative treatments have been proposed to avoid the post-splenectomy complications. In this study, we propose such a procedure (laparoscopic ligation of splenic vessels, L-LSV) for the treatment of HS in children and investigate its effectiveness and feasibility.

Materials and methods

A total of 17 children with HS who underwent the L-LSV at our hospital between May 2015 and Apr 2018 were enrolled in the current study. All patients were followed-up for 3–38 months (mean 19.8 months). The volume of spleen was preoperatively and postoperatively measured using the AW VolumeShare5. The size of functional spleen and the condition of splenic infarction were evaluated using ultrasound and computed tomography (CT) after surgery. The routine blood, biochemistry and coagulation tests were carried out after surgery.

Results

The L-LSV was successfully performed in all patients. The average operative time was 115 min (range 60–180 min). No patients underwent blood transfusion during surgery, and the length of hospital stay varied 5–9 days after surgery (mean 7 days). Postoperatively, the red blood cells, platelet and hemoglobin were significantly increased (P < 0.05). The postoperative volume of functional spleen was significantly smaller than preoperative volume of spleen (307.393 ± 177.634 cm3 vs. 581.242 ± 270.260 cm3, P = 0.000). The recent volume of functional spleen was significantly bigger than the postoperative 1 month volume of functional spleen in ten children who were followed-up for more than 1 year (P = 0.004). The index of splenic infarction (the proportion of the postoperative 1-month volume of splenic infarction in the preoperative volume of spleen) was 0.31–0.99 (mean 0.53). There were no patients undergoing the blood transfusion after surgery.

Conclusions

The L-LSV is an effective treatment for HS in children; however, future studies should re-evaluate the long-term prognosis.
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Metadata
Title
Laparoscopic ligation of splenic vessels for the treatment of hereditary spherocytosis in children
Authors
Jin-Shan Zhang
Long Li
Publication date
01-03-2020
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 3/2020
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-020-04623-1

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