Comparative Effectiveness of Different Types of Splenectomy for Children with Congenital Hemolytic Anemias

Objective To compare the effectiveness of different types of splenectomy in children with congenital hemolytic anemias. Study design We constructed key questions that addressed outcomes relevant to clinicians and families on effects of partial or total splenectomy, including hematologic effect, sple...

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Bibliographic Details
Published in:The Journal of pediatrics 2012-04, Vol.160 (4), p.684-689.e13
Main Authors: Rice, Henry E., MD, Crary, Shelley E., MD, Langer, Jacob C., MD, Kemper, Alex R., MD, MPH, MS
Format: Article
Language:English
Subjects:
Anemia, Hemolytic, Congenital - surgery
Anemias. Hemoglobinopathies
Biological and medical sciences
Child
children
data collection
Diseases of red blood cells
General aspects
Hematologic and hematopoietic diseases
Humans
laparoscopy
laparotomy
Liver, biliary tract, pancreas, portal circulation, spleen
Medical sciences
Pediatrics
randomized clinical trials
risk
Splenectomy - methods
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Treatment Outcome
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Summary:Objective To compare the effectiveness of different types of splenectomy in children with congenital hemolytic anemias. Study design We constructed key questions that addressed outcomes relevant to clinicians and families on effects of partial or total splenectomy, including hematologic effect, splenic function, and the risk of adverse events. We identified from Pubmed and Embase 703 studies that evaluated different types of splenectomy and accepted 93 studies that satisfied entry criteria. We graded the quality of each report and summarized the overall strength of research evidence for each key question. Results We did not identify any randomized clinical trials. All types of splenectomy have favorable clinical outcomes in most diseases. We did not identify any hematologic advantage of laparoscopy compared with laparotomy. Adverse events are uncommon in most studies and are minimized with use of laparoscopy. Conclusions There is a need for randomized clinical trials and improved data collection of different types of splenectomy in congenital hemolytic anemias. Outcomes studied should address the concerns of families and clinicians to assess the risks and benefits of various treatments.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2011.09.030