Keyhole Spleen Removal Suggested as Feasible Option for Sickle Cell Disease Children

Removing the spleen by keyhole surgery is a feasible option for children with sickle cell disease, according to a study that explored the procedure as the sole therapeutic intervention.

But because the study described only short-term outcomes, researchers underscored that more research is needed to investigate how a splenectomy affects the health of children in the long run.

The study, “Laparoscopic Splenectomy Alone for Sickle Cell Disease,” was published in the Sultan Qaboos University Medical Journal.

Spleen removal is not uncommon in patients with sickle cell disease, but it rarely has been studied as the sole procedure in children, particularly in the Middle East. Most previous studies had either mixed patient populations, in which patients underwent spleen removal for various reasons, or included sickle cell patients who had other surgical procedures at the same time.

So, researchers at the Sultan Qaboos University Hospital in Oman studied 50 children, 28 boys and 22 girls, with sickle cell disease who underwent keyhole splenectomy as the only procedure.

The most common reason for spleen removal among the children was recurrent splenic sequestration crisis, accounting for 92% of the procedures. This condition results as faulty red blood cells clog up the spleen, which can cause a life-threatening blood circulation crisis.

This mostly happens in children younger than five years, and 60% of the patients in the study were aged five or below. The mean age of the patients was six.

The surgery is a rather short procedure, and operating times ranged between 66–204 minutes. One-fifth of the patients required blood transfusions, either during or after the surgery.

Only one patient required conversion from a keyhole procedure to open surgery because of excessive bleeding. Seven patients, amounting to 14%, had postoperative complications, including acute chest syndrome occurring in four children. This is a condition in which the sickled red blood cells block lung blood vessels, and is linked to the disease rather than the surgery.

The study only described the procedures, and while researchers found the surgery to be a safe option, they did not follow the children after hospital discharge. Consequently, the research team suggested that more studies are needed to explore how removal of the spleen impacts long-term outcomes and the quality of life of sickle cell patients who have their spleen removed.