Rt. Schlinkert et D. Mann, LAPAROSCOPIC SPLENECTOMY OFFERS ADVANTAGES IN SELECTED PATIENTS WITH IMMUNE THROMBOCYTOPENIC PURPURA, The American journal of surgery, 170(6), 1995, pp. 624-627
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.