Laparoscopic Subtotal Splenectomy in Pediatric Patients With Hematologic Disorders: A Case Series and Operative Technique.

INTRODUCTION

Total splenectomy in children increases the risk of overwhelming post-splenectomy infection (OPSI). Laparoscopic subtotal splenectomy (LSS) is a technique to preserve splenic function while managing disease burden in pediatric hematologic disorders.

MATERIALS AND SURGICAL TECHNIQUE: Three children aged 4 to 9 years with juvenile myelomonocytic leukemia (JMML) or hereditary spherocytosis underwent LSS. All received pneumococcal vaccination and preoperative CT imaging. Under general anesthesia, three 5-mm trocars were used. Intraoperative indocyanine green (ICG) fluorescence imaging guided perfusion assessment. In one case, an upper pole was preserved due to anatomical considerations. In two cases, LSS was combined with laparoscopic cholecystectomy. Approximately 90 to 97% of the spleen was resected, leaving a 30 mL remnant.

DISCUSSION: All patients recovered well without OPSI. One case required transfusion. ICG imaging enabled safe resection with preserved perfusion. No case developed splenosis or required completion splenectomy during follow-up. LSS is a feasible technique for selected pediatric patients to minimize infection risk while maintaining immunologic function.