Paediatric splenectomy: The Johannesburg experience

Abstract

Background. Splenectomy is an uncommon procedure in children, and data on children who underwent splenectomy in South Africa are sparse.

Objective. To describe the profile, operative management and outcomes of children undergoing splenectomy.

Methods. The records for all children aged 0 to 16 years who underwent splenectomy at Charlotte Maxeke Johannesburg Academic (CMJAH) and Chris Hani Baragwanath Academic (CHBAH) hospitals between 2000 and 2015 were reviewed. Student’s t-tests and χ² tests were used to analyse the data.

Results. The mean age at surgery was 9.9 years (range 3-16). Most splenectomies (91%; n=30/33) were performed for haematological disorders and were open (67%; n=22/33). The mean post-operative length of stay (LOS) was shorter in the laparoscopic (4.5 days) than the open (7.1 days) groups (p<0.05). Surgical complications were more common in the laparoscopic (36%, 4/11) than open (9%; n=2/22) group, and in children older than the mean age at time of surgery. No cases of overwhelming post splenectomy infection (OPSI) were noted. At study completion, 61% (n=20/33) of patients were alive, 9% (n=3/33) had demised, and 30% (n=10/33) were lost to follow-up.

Conclusion. Local indications for paediatric splenectomy mirror those found in international literature. Mean and median postoperative lengths of stay (LOS) were shorter in the laparoscopic than open group, but relatively longer for both groups than reported internationally. Laparoscopy is not currently the preferred technique for splenectomy in our setting. All mortalities were due to progression of underlying disease and no cases of OPSI were recorded. The high loss-to-follow-up rate in this study is a significant barrier to accurate data collection, analysis and reporting.