Laparoscopic splenectomy for immune thrombocytopenic purpura.

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.