LAPAROSCOPIC SPLENECTOMY OFFERS ADVANTAGES IN SELECTED PATIENTS WITH IMMUNE THROMBOCYTOPENIC PURPURA

BACKGROUND: Splenectomy plays a crucial role in the management of sele cted 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 p atients undergoing splenectomy for ITP at our institution from June 19 87 to August 1994. RESULTS: Twenty-one patients underwent splenectomy for ITP. Fourteen open procedures (group 1) and 7 laparoscopic procedu res (group 2) were performed. Eleven of 14 patients in group 1 and all 7 patients in group 2 had appropriate increases in platelet count fol lowing surgery. There were 3 complications in group 1 and no major com plications in group 2. Operative time was longer in group 2 (154 versu s 68 minutes, P <0.05), but decreased with experience (210 to 135 minu tes), Compared with patients in group 1, patients in group 2 tolerated liquids sooner (0.7 versus 2.6 days, P <0.05), required less parenter al narcotic (14 versus 65 morphine equivalents, P <0.05), and were dis charged sooner (2.1 versus 5 days, P <0.05). All patients in group 2 r emain well and require no medication after a mean follow-up of 11 mont hs. CONCLUSIONS: Laparoscopic splenectomy is safe and effective in the management of select patients with ITP and offers advantages over ope n techniques.