Introduction: The first laparoscopic splenectomy was done in 1991 and the pediatric laparoscopic procedure was performed in 1993. In Russian Federation the first pediatric laparoscopic splenectomy was performed by Prof. Poddubny in 1996.

Aim: The aim of this study is to assess our experience in development, progress and safety of laparoscopic splenectomy in children with benign hematologic diseases during the 25 years period.

Materials and Methods: laparoscopic splenectomy using four laparoscopic ports were employed (1996–2006) in 112 children. Since 2007, a three-port approach with combined patient positioning has been used; a fourth port was added during concomitant cholecystectomy (performed in 122 patients, 23%). The splenic vascular pedicle was transected using a linear stapler in 72 cases (13.5%) and ligasure Atlas for vascular control in 457 cases. 

Vaccination against S. pneumoniae, H. influenzae type B, and N. meningitidis was administered one month preoperatively. Since 2005, octreotide (Sandostatin) was given 30 minutes before surgery to reduce pancreatic secretory activity.

Results: Operation time ranged from 25 to 240 minutes (mean 72), extending to 85–240 minutes (mean 120) if cholecystectomy was performed. Intraoperative blood loss varied from 30 to 110 ml, with no transfusions. No conversions to open surgery occurred. Early postoperative bleeding was observed in four patients: one due to splenic artery autolysis (requiring laparotomy) and three due to stapler line failure, which were managed laparoscopically. Postoperative pancreatitis incidence decreased from 19% pre-octreotide to 3.4% after its introduction. Fourteen patients showed elevated urine amylase (>1000 IU). One patient developed distal pancreonecrosis complicated by pseudocyst formation with gastric and colonic fistulas, necessitating distal pancreatectomy, partial gastrectomy, and splenic flexure resection.

Conclusions: Laparoscopic splenectomy is a gold standard procedure in pediatric surgery. Modern coagulation and transection devices facilitate safe and effective surgery accessible to a wide range of pediatric surgeons. However, spleen size may impose limitations, particularly during early experience. Combined intraoperative access allows for clear visualization and safe dissection of the vascular pedicle without compromising anatomic orientation, enabling secure spleen extraction.

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