LAPAROSCOPIC SPLENECTOMY FOR IDIOPATHIC THROMBOCYTOPENIC PURPURA - COMPARISON OF LAPAROSCOPIC SURGERY AND CONVENTIONAL OPEN SURGERY

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.