Laparoscopic versus open splenectomy in non-traumatic pediatric patients: a systematic review and meta-analysis.

BACKGROUND: Laparoscopic splenectomy (LS) is the preferred surgical approach for pediatric patients requiring splenectomy, though gaps remain regarding spleen size impact on outcomes and conversion rates, especially in children with hematologic disorders. METHODS: A comprehensive literature search was conducted across PubMed, Medline, CINAHL, Embase, and Cochrane Library, from inception to January 2025, following PRISMA guidelines and registered with PROSPERO (CRD42025644989). Statistical analysis was performed using a random-effects model. RESULTS: The initial search yielded 216 studies, 19 studies with 1898 pediatric patients included. Of those, 1202 underwent LS and 696 open splenectomy (OS). LS was associated with shorter hospital stay (MD: -1.59 days, 95% CI: -2.18 to -1.00, P < 0.00001), faster initiation of oral feeding (MD: -0.68 days, 95% CI: -1.07 to -0.29, P = 0.0006), fewer transfusions (OR = 0.38, 95% CI: 0.23 to 0.62, P = 0.0001), and conversion to OS in 2.7% of cases. OS showed shorter operative time (MD: 60.4 min, 95% CI: 37.4 to 83.4, P < 0.00001), and improved accessory spleen removal (OR: 1.91, 95% Cl: 1.02 to 3.57, P = 0.04). CONCLUSION: Our findings support LS as a safe and effective technique in pediatric hematologic patients and provide updated evidence to guide surgical decision-making.