Laparoscopic splenectomy offers advantages in selected patients with immune thrombocytopenic purpura.

BACKGROUND

Splenectomy plays a crucial role in the management of selected patients with immune thrombocytopenic purpura (ITP). Laparoscopic splenectomy has been suggested as an alternative to open techniques.

MATERIALS AND METHODS

A retrospective chart review was made for all patients undergoing splenectomy for ITP at our institution from June 1987 to August 1994.

RESULTS

Twenty-one patients underwent splenectomy for ITP. Fourteen open procedures (group 1) and 7 laparoscopic procedures (group 2) were performed. Eleven of 14 patients in group 1 and all 7 patients in group 2 had appropriate increases in platelet count following surgery. There were 3 complications in group 1 and no major complications in group 2. Operative time was longer in group 2 (154 versus 68 minutes, P < 0.05), but decreased with experience (210 to 135 minutes). Compared with patients in group 1, patients in group 2 tolerated liquids sooner (0.7 versus 2.6 days, P < 0.05), required less parenteral narcotic (14 versus 65 morphine equivalents, P < 0.05), and were discharged sooner (2.1 versus 5 days, P < 0.05). All patients in group 2 remain well and require no medication after a mean follow-up of 11 months.

CONCLUSIONS

Laparoscopic splenectomy is safe and effective in the management of select patients with ITP and offers advantages over open techniques.