Surgical management of pediatric primary splenic lesions: safety and feasibility of transumbilical single-port laparoscopic partial splenectomy.

backgroundThis study retrospectively analyzed the clinical characteristics of pediatric patients with primary splenic lesions and evaluated the safety and efficacy of partial splenectomy as a spleen-preserving surgical approach. Emphasis was placed on assessing the feasibility and cosmetic outcomes of transumbilical single-port laparoscopic partial splenectomy.

methodsA total of 23 pediatric patients with primary splenic diseases were treated at a single institution between January 2014 and December 2024. Clinical presentations, imaging findings, surgical techniques, pathological diagnoses, perioperative complications, and postoperative platelet trends were reviewed. Patients were categorized into three groups based on the surgical approach: conventional laparoscopic partial splenectomy (CL group), transumbilical single-port laparoscopic partial splenectomy with an auxiliary port (SPL + 1 group), and pure transumbilical single-port laparoscopic partial splenectomy (SPL group). Surgical and postoperative outcomes were compared among these groups.

resultsThe cohort consisted of 16 boys and 7 girls, with ages ranging from 1.4 to 14 years at the time of surgery. Clinical presentations included abdominal distension (n = 2), hematemesis (n = 1), and bicytopenia (n = 1), while the remaining 19 cases were incidentally detected via imaging. Lesion diameters ranged from 2.2 to 8.1 cm. Pathological diagnoses included vascular malformation (10/23), splenic cyst (6/23), littoral cell angioma (5/23), hamartoma (1/23), and wandering spleen (1/23). Partial splenectomy was performed either through open surgery or minimally invasive techniques (CL, SPL + 1, or SPL approaches). Among the minimally invasive groups, significant differences (P < 0.05) were observed in hospitalization costs, peak postoperative platelet count, and scar assessment scores (Patient and Observer Scar Assessment Scale, patient/parent version). The most common postoperative complication was localized fluid collection in the abdominal, pelvic, or perisplenic regions.

conclusionsVascular malformations, splenic cysts, and littoral cell angiomas are the most common primary splenic lesions in children. Partial splenectomy is a safe and effective spleen-preserving treatment. Notably, transumbilical single-port laparoscopic partial splenectomy is minimally invasive and offers superior cosmetic results, making it particularly suitable for pediatric patients.