TY - JOUR
T1 - Splenic function is not maintained long-term after partial splenectomy in children with sickle cell disease
AU - El-Gohary, Yousef
AU - Khan, Sidrah
AU - Hodgman, Erica
AU - Wynn, Lynn
AU - Kimble, Amy
AU - Abdelhafeez, Abdelhafeez
AU - Talbot, Lindsay
AU - Wang, Winfred
AU - Davidoff, Andrew M.
AU - Murphy, Andrew J.
N1 - Funding Information:
This work was supported by the American Lebanese Syrian Associated Charities (ALSAC/St. Jude Children's Research Hospital).
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/11
Y1 - 2020/11
N2 - Background: Partial splenectomy (PS) may allow preservation of splenic function in cases where splenectomy is indicated for hematologic diseases; however, the long-term outcomes are uncertain. We investigated the long-term outcomes of PS in patients with sickle cell disease (SCD). Methods: A single-institution retrospective chart review was performed for children with SCD who underwent PS from 1997 to 2017. For comparison, we reviewed outcomes for patients who underwent PS for hereditary spherocytosis (HS). The primary endpoint was viability of the splenic remnant as inferred by the presence of remnant perfusion on ultrasound and/or liver spleen scan. Results: Nine patients with SCD and 26 patients with HS underwent PS at a median age of 11 (IQR, 9–14) and 7.5 (IQR, 6–13) years, respectively. All underwent laparoscopic PS with three (7.9%) conversions to open. Two SCD patients were lost to long-term follow-up. The remaining seven SCD patients had initial postoperative splenic remnant perfusion demonstrated by ultrasonography. By 42 months postoperatively, however, none had a functioning splenic remnant. The median time to loss of splenic remnant was 12.6 (IQR 9.2–28.5) months. In contrast, all HS patients demonstrated robust splenic remnant blood flow with a median follow-up of 46 (IQR 37–82) months. Conclusion: No patient with SCD who underwent PS had viable splenic tissue for more than 42 months, likely due to continued autoinfarction typical of patients with this disease. Therefore, we believe that PS to preserve splenic function is not indicated in patients with SCD. Level of evidence: III.
AB - Background: Partial splenectomy (PS) may allow preservation of splenic function in cases where splenectomy is indicated for hematologic diseases; however, the long-term outcomes are uncertain. We investigated the long-term outcomes of PS in patients with sickle cell disease (SCD). Methods: A single-institution retrospective chart review was performed for children with SCD who underwent PS from 1997 to 2017. For comparison, we reviewed outcomes for patients who underwent PS for hereditary spherocytosis (HS). The primary endpoint was viability of the splenic remnant as inferred by the presence of remnant perfusion on ultrasound and/or liver spleen scan. Results: Nine patients with SCD and 26 patients with HS underwent PS at a median age of 11 (IQR, 9–14) and 7.5 (IQR, 6–13) years, respectively. All underwent laparoscopic PS with three (7.9%) conversions to open. Two SCD patients were lost to long-term follow-up. The remaining seven SCD patients had initial postoperative splenic remnant perfusion demonstrated by ultrasonography. By 42 months postoperatively, however, none had a functioning splenic remnant. The median time to loss of splenic remnant was 12.6 (IQR 9.2–28.5) months. In contrast, all HS patients demonstrated robust splenic remnant blood flow with a median follow-up of 46 (IQR 37–82) months. Conclusion: No patient with SCD who underwent PS had viable splenic tissue for more than 42 months, likely due to continued autoinfarction typical of patients with this disease. Therefore, we believe that PS to preserve splenic function is not indicated in patients with SCD. Level of evidence: III.
KW - Hereditary spherocytosis
KW - Partial splenectomy
KW - Sickle cell disease
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U2 - 10.1016/j.jpedsurg.2019.12.006
DO - 10.1016/j.jpedsurg.2019.12.006
M3 - Article
C2 - 31973928
AN - SCOPUS:85078037074
VL - 55
SP - 2471
EP - 2474
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 11
ER -