Clinical Study Impact of Spleen Size on Outcomes in Laparoscopic Splenectomy in Children Cetin Ali Karadag, Basak Erginel, Ozgur Kuzdan, Nihat Sever, Melih AkJn, Abdullah YJldJz, and Ali Ehsan Dokucu Department of Pediatric Surgery, Sisli Etfal Training and Research Hospital, 34360 Istanbul, Turkey Correspondence should be addressed to Basak Erginel; basakerginel@hotmail.com Received 1 September 2014; Accepted 17 December 2014 Academic Editor: Colin Knight Copyright © 2015 Cetin Ali Karadag et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Te aim of our study is to compare the efcacy of laparoscopic splenectomy (LS) between enlarged spleens and normal sized spleens. Methods. From June 2006 to September 2012, 50 patients underwent LS. Te patients consisted of 24 girls and 26 boys with the mean age of 8.64 years (1–18). Te patients are divided into two groups according to spleen’s longitudinal length on the ultrasonography. Group I consisted of the normal sized spleens; Group II consisted of spleens that are exceeding the upper limit. Groups are compared in terms of number of ports, operative time, rate of conversion to open procedure, and length of hospital stay. Results. Te mean number of ports was 3.27 and 3.46, the mean length of the operation was 116.36 min and 132.17 min, rate of conversion to open procedure was 9.09% and 10.25%, and the mean length of hospital stay was 3.36 days and 3.23 days, respectively, in Group I and Group II. Although there is an increase in the number of the ports, the operative time, rate of conversion to open procedure, and the length of hospital stay, the diference was not signifcant between groups ( > 0.05). Conclusion. LS is safe and efective in enlarged spleens as well as normal sized spleens. 1. Introduction Laparoscopic splenectomy was frst performed by Delaitre and Maignien in 1991 [1]. Aferwards, it gained acceptance and became preferred to the traditional open procedure because of the less postoperative pain, shorter hospital stays, quicker wound healing, and better cosmetic results [2]. How- ever, in cases of large spleens, its proper place is still being discussed [3]. Te aim of our study is to evaluate the outcome of laparoscopic splenectomy in cases of large spleens. 2. Materials and Methods 2.1. Patient Selection and Study Design. Tis is a retrospec- tive cohort study to compare laparoscopic splenectomy in children with normal sized spleens and patients with splenic lengths exceeding the upper limits based on the patients’ ages (Table 1). From June of 2006 to September of 2012, 50 patients underwent laparoscopic splenectomy (LS) at our institution. All of them underwent total splenectomy. Te demographic fndings of the patients are listed in Table 2. Group I consisted of 11 patients with splenic lengths of normal size, and Group II consisted of 39 patients with splenic lengths exceeding the upper limits based on the patients’ ages. All patients received pneumococcal, meningococcal, and Haemophilus infuenza vaccines preoperatively, and upon discharge, they were given long-acting intramuscular penicillin every 3 weeks for 2-3 years postoperatively. 2.2. Technique. Laparoscopic splenectomies (LS) were under- taken in a semilateral position. Under general anaesthesia, a nasogastric tube and a Foley catheter are applied. Te patient is placed on his right side in a 15 ∘ reverse Trendelenburg position. A 15 mm trocar is inserted through the umbilicus for telescope and the removal of the spleen. A 5 mm port is inserted in the middle point of the line between the umbilicus and xiphoid process for a grasper. A further 5 mm port is placed to the margin of the lef pararectal line below the umbilicus. Tis port is usually used for Ligasure. Te intra-abdominal pressure is adjusted to 10–12 mmHg. In 20 patients, one additional port was inserted craniolaterally Hindawi Publishing Corporation Gastroenterology Research and Practice Volume 2015, Article ID 603915, 4 pages http://dx.doi.org/10.1155/2015/603915