M. Hashizume et al., LAPAROSCOPIC SPLENECTOMY FOR IDIOPATHIC THROMBOCYTOPENIC PURPURA - COMPARISON OF LAPAROSCOPIC SURGERY AND CONVENTIONAL OPEN SURGERY, Surgical laparoscopy & endoscopy, 6(2), 1996, pp. 129-135
In chronic idiopathic thrombocytopenic purpura (ITP), the two main the
rapeutic choices are steroid treatment or splenectomy. The adult form
of ITP is described as a disease found primarily in young adults, with
a female predominance. Treatment with steroids effects a complete res
ponse in less than 30% of patients, whereas splenectomy is successful
in more than 60% of patients who undergo it. The minimal access afford
ed by laparoscopic splenectomy is considered highly desirable for thes
e patients. The purpose of this study was to compare the clinical bene
fits of a laparoscopic splenectomy with those of conventional open sur
gery for patients with ITP. From 1968 to 1993, splenectomy was perform
ed on 51 patients: 10 operations done laparoscopically and 41 performe
d conventionally. Complications, postoperative pain, recovery, and hos
pital charges were then compared. Laparoscopic splenectomy involved mi
nimal incisions, and a significantly lower frequency of analgesia was
required for postoperative abdominal pain (1.3 vs. 3.3); hospital stay
was shorter (8.2 vs. 20.1 days) (p < 0.005). Operative time was signi
ficantly longer for the laparoscopic surgery (249.2 vs. 99.8 min) (p <
0.0001), but blood loss was less (176.0 vs. 511.7 g) (p < 0.01). No i
ntraoperative or postoperative major complications occurred with the l
aparoscopic procedures, compared with 46.3% with conventional surgery.
Finally, the total hospital costs were lower with laparoscopic splene
ctomy, especially for postoperative care (p < 0.05). A laparoscopic sp
lenectomy may well be considered the surgical treatment of choice for
patients requiring a splenectomy in view of both quality of life and e
conomy.