Splenectomy: Long-term Outcomes in Kids

Pediatric splenectomy is performed frequently for various indications, with hereditary spherocytosis, idiopathic thrombocytopenic purpura, sickle cell anemia, and malignant hematologic diseases the most common causes.

Pediatric splenectomy is performed frequently for various indications, with hereditary spherocytosis, idiopathic thrombocytopenic purpura, sickle cell anemia, and malignant hematologic diseases the most common causes.

The complication rate approaches 10%, and portal vein thromboisis—which has been reported to occur in about 6% of children who have a splenectomy—can be fatal or result in long-term problems.

A study published ahead-of-print in the journal Surgery answers some questions about long-term outcome after splenectomy in a pediatric population.

This study followed 141 consecutive children who had splenectomies for an average of 8.7 years. The researchers looked specifically for sepsis, portal vein thrombosis (PVT), and retained accessory spleen. The majority of children (63%) had open splenectomies. Data was pulled from a national registry, hospital records, and from surveys competed by 58% of patients.

The median operation age was 8.8 years. Reoperation for bleeding after open procedures was necessary in only one patient, and only three had retained accessory spleen after laparoscopic procedures. The researchers found that overall, surgeons had failed to identify and remove at least 10 accessory spleens.

Twenty-seven patients died during the follow-up period, and the most common cause of death was an underlying malignancy. Sepsis was an additional cause of death in five patients.

Eleven patients developed post-splenectomy sepsis, with the median occurrence at 1.7 years. Ten of the 11 patients had underlying immunodeficiencies.

PVT was not reported or documented using abdominal ultrasound or at autopsy.

The researchers found that physicians prescribed antibiotic prophylaxis inconsistently during the study period.

At the beginning of the study period, several antibiotic regimens were employed. Some patients received nothing in terms of prophylaxis. Prescribers used penicillin almost exclusively for two years postoperatively in the last 15 years of the study. Patients with severe underlying primary disease associated with immunodeficiency were given various antibiotics under no consistent protocol.