A Comparison of Single-Incision Versus Multiport Laparoscopic Splenectomy in Children.

Background: Although single-incision endoscopic splenectomy (SIES-Sp) has been shown to be feasible and safe, few have compared the SIES-Sp with multiport laparoscopic splenectomy (MPLS). The purpose of this study was to compare the two techniques in children undergoing total splenectomy. Materials and Methods: We reviewed all children (age <18 years) who underwent minimally invasive total splenectomy at a single tertiary referral center from January 1, 2000 to January 1, 2019. The primary outcome was complication rate 30 days after discharge defined by maximum Clavien-Dindo score. Secondary outcomes included conversion, operative time, hospital length of stay, postoperative pain scores, and readmission within 30 days of discharge. SIES-Sp and MPLS were compared using univariate analysis. Results: Of 48 children undergoing laparoscopic total splenectomy, 60% ( n  = 29) were SIES-Sp and 40% ( n  = 19) were MPLS. Subjects were 48% female ( n  = 23). Common diagnoses were idiopathic thrombocytopenic purpura (33% [ n  = 16]), hereditary spherocytosis (29% [ n  = 14]), and other congenital hemolytic anemias (23% [ n  = 11]). There were no differences in age, gender, or diagnosis between groups (all P  > .05). One in three cases involved additional procedures. Spleens were smaller in both greatest dimension (13.0 cm versus 16.4 cm) and weight (156.5 g versus 240.0 g) in SIES-Sp compared with MPLS patients (both P  < .05). Readmission and reoperation rates were similar (both P  > .05). Complications occurred in 7% ( n  = 2) of SIES-Sp and in 11% ( n  = 2) of MPLS patients ( P  > .99). Severe complications included: cardiac arrest in 1 SIES-Sp patient and bleeding requiring reoperation in 1 MPLS patient. Conclusion: SIES-Sp is a safe alternative to the traditional MPLS for children. Additional procedures do not preclude a less invasive approach, but larger spleens may present a challenge.