This study aimed to determine whether laparoscopic splenectomy is more advantageous than open splenectomy in pediatric patients. Data from 61 patients treated between June 1983 and September 1994 were reviewed. Length of hospitalization, hospital costs, operating time, and postoperative complications were evaluated. Forty-seven patients had open splenectomy. Nineteen of these underwent concomitant procedures. Fourteen patients had laparoscopic splenectomy, and four had concomitant cholecystectomy. The data show a trend toward a 1-day reduction in hospital stay associated with laparoscopic splenectomy (P < .02). Operating time was 83% longer for the laparoscopic approach (P < .001), and operating costs were almost $3,000 more (P < .001) than for open splenectomy. The total hospital cost also was greater for laparoscopic procedures (P < .1), primarily reflective of a more than $3,000 difference for splenectomy alone (P < .02). Two of the fourteen laparoscopic patients (14%) had complications. One patient with Evan's syndrome had pneumonia that required antibiotics. Another patient required conversion to an open procedure because of poorly controlled hemorrhage from a short gastric vessel. Twelve of the open splenectomy patients (25%) had complications: atelectasis (3), fever (4), wound infection (2), pneumonia (1), laryngospasm (1), and pancreatitis (1). The authors conclude that laparoscopic splenectomy is a safe but currently more expensive alternative to open splenectomy, primarily because of the use of disposable instruments. Benefits include a shorter hospital stay, no greater risk of postoperative complications, and subjective improvement in the cosmetic result. Disadvantages include increased operating time and cost. Evaluation of larger series will be needed to determine the significance of the difference in complication rates between the two procedures.