Aim of the Study
Subtotal splenectomy (preservation of 1/5-1/6 th of the spleen) in sickle cell disease (SCD) aims to prevent recurrent episodes of acute splenic sequestration (ASS) and preserve the immunologic and filter spleen’s functions (Sissoko e al, AM J Hematol, 2024). The aim of this study is to demonstrate its feasibility and safety and discuss its role in SCD treatment.
Methods
We reviewed the chart of all the SCD children who underwent a robotic subtotal splenectomy (RSS) for repeated sequestration episodes from April 2016 to December 2023. Clinical, operative, post-operative and follow-up records were collected and compared to the literature using standard statistic tests.
Main results
38 patients were included. The median age and weight at surgery were 5 years [3-15] et 18.6 Kg [12-42]. 50% patients were in a transfusion program and had a median of 2 ASS’s episodes before surgery. Median operative time was 158 minutes [97-360], there were no conversion, only 1 patients needed intraoperative transfusion. Post- operative complications included 3 episodes of acute thoracic syndrome, 1 peripheral vaso-occlusive crisis, 1 Choledocholithiasis needing CPRE after associated cholecytstectomy (Clavien Dindo III). Median hospital stay was 4,5 days [2-22]. During the follow-up (median 4 years) no patient presented ASS.
Conclusion
Robotic subtotal splenectomy in SCD children is safe and prevent ASS recurrence. In our series we didn’t encountered major intraoperative complications. The average hospital stay is aligned with the literature. Moreover with adequate supervision, the learning curve for robotic surgery is correct, with no increase in operating time.
Keywords: Robotic subtotal splenectomy, sickle cell disease
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