Akihiko Hara

Laparoscopic splenectomy in children

To determine the safety and efficiacy of laparoscopic splenectomy (LS) in children, a retrospective review of our preliminary experience using LS was compared to results in patients who previously underwent open splenectomy (OS). From July 1993 to January 1995, we performed eight LS procedures in six children with hereditary spherocytosis (HS) and two with immune thrombocytopenic purpura (ITP). Laparoscopic cholecystectomy was simultaneously done in one case with HS. There were 4 males and 4 females who ranged in age from 5 to 15 years—an average age of 8.8 years. Two cases in the early series required a counterincision because of bleeding. Eleven patients who previously underwent OS in our department were used to compare demographics, operative courses, and surgical outcomes. The ages, genders, diseases, body weights, and spleen weights were comparable between LS group and OS groups. The operative time for the LS group was statistically longer than for the OS group (226±24 min vs 101±8 min, P<0.001). The estimated blood loss in the LS group was similar to that of the OS group (100±39 ml vs 73±11 ml, P=0.97). There were no peri- or postoperative complications in two groups. The postoperative hospital stay of LS group was statistically shorter than that of the OS (6.8±0.6 days vs 10.4±0.5 days, P<0.001). LS provided better cosmesis and minimized trauma in children over OS. LS appears to be a safe and effective procedure in children, and is useful in the management of pediatric patients with HS or ITP.

Hemostasis for the Ramstedt procedure: Use of a fibrin adhesive

Pre- and postoperative blood counts were retrospectively compared between patients with no hemostatic management (group A,n = 30) and patients with a fibrin adhesive (Beriplast P) applied to the cut edges (group B,n = 8) when pyloromyotomy was performed for hypertrophic pyloric stenosis. Postoperative red blood cell count, hematocrit, and hemoglobin were significantly decreased in group A (P <0.01) while there was no significant change in group B. It has been stated that the Ramstedt operation does not require any special hemostatic management. However, as postoperative peritoneal bleeding is suspected, hemostatic management with a fibrin adhesive applied to the incised region of the serosa and muscle layer is recommended.