Long-term outcomes after pediatric splenectomy

• Published in: Surgery 2016-06, Vol.159 (6), p.1583-1590
• Main Authors: Luoto, Topi T., MD, Pakarinen, Mikko P., MD, Koivusalo, Antti, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Laparoscopy - adverse effects; Male; Portal Vein; Postoperative Complications - epidemiology; Sepsis - epidemiology; Splenectomy - adverse effects; Splenic Diseases - mortality; Splenic Diseases - surgery; Surgery; Time Factors; Treatment Outcome; Venous Thrombosis - epidemiology; Young Adult
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2015.12.014

Background Splenectomy is performed frequently for various and primarily hematologic indications in children and adolescents. We analyzed the long-term outcome after splenectomy (median, 8.7 years) focusing on sepsis, portal vein thrombosis (PVT), and retained accessory spleen. Methods In total, 141 consecutive children after open ( n  = 89; 63%) or laparoscopic ( n  = 52; 37%) splenectomy from 1991 to 2010 were followed up through nationwide registries for septic infections, PVT, and causes of death. Sixty-six patients (58% of survivors) answered a structured questionnaire on infections, abdominal symptoms, and general health, and 64 (laparoscopic n  = 26, open n  = 38) consented to ultrasonography of the portal venous system. Results Median operation age was 8.8 years (range, 1.0–22). Reoperations were required for bleeding after open procedures ( n  = 1) and retained accessory spleen after laparoscopic procedures ( n  = 3). Postsplenectomy sepsis occurred after a median of 1.7 years (range, 0.2–5.9) in 11 patients (8%), of whom 10 had an underlying immunodeficiency. No cases of PVT were observed, although the median portal vein flow was 1,130 mL/min (range, 440–2200) and diameter was 9.9 mm (range, 7–15) at a median follow-up of 9.5 years (range, 2.0–22) after splenectomy. Twenty-seven patients (19%) died after 8.7 years (0.03–23.00). The most common cause of death was the underlying malignancy ( n  = 15), with sepsis being an additional cause of death in 5 patients. Conclusion Postsplenectomy sepsis was associated almost exclusively with an underlying immunodeficiency with a high mortality rate. No PVT was observed. The overall risk of retained accessory spleen was around 7%, and was slightly greater after laparoscopic operation.