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Laparoscopic splenectomy for immune thrombocytopenic purpura
1Mayo Clinic, Rochester, Minn, USA.
Objective:
To evaluate laparoscopic splenectomy as a treatment of immune thrombocytopenic purpura (ITP).
Design:
Retrospective review of 18 patients followed up from 1 to 30 months.
Setting:
Referral center using community hospital.
Patients:
Consecutive series of patients undergoing laparoscopic splenectomy for ITP.
Intervention:
Laparoscopic splenectomy.
Main Outcome Measure:
Surgical and hematologic results.
Results:
Eighteen patients underwent laparoscopic splenectomy for ITP. All procedures were completed laparoscopically. There was no perioperative mortality. Pancreatitis developed in 1 patient (6%); 17 (94%) of 18 patients responded to splenectomy. The mean platelet count increased from 29 x 10(9) to 461 x 10(9)/L after laparoscopic splenectomy and stabilized at 327 x 10(9)/L (mean follow-up period, 15 months). Mean (+/- SEM) operative blood loss was 214 +/- 52 mL, necessitating no transfusions. Mean hospital stay was 2 days (range, 1-7 days). Most patients tolerated a liquid diet the day of the operation and a solid diet the next day. Parenteral narcotic usage averaged 12.3 morphine equivalent units, and 6 patients (33%) required no parenteral analgesia. An accessory spleen was identified in 1 patient (6%). Mean (+/- SEM) operative time was 130 +/- 8 minutes and was significantly less in the second half of our experience (117 vs 144 minutes, P = .04).
Conclusions:
Laparoscopic splenectomy is safe and effective for the management of ITP and allows rapid recovery. With increasing experience, operative times decrease. Laparoscopic splenectomy should be the treatment of choice for patients with ITP who require splenectomy.