IS LAPAROSCOPIC SPLENECTOMY A JUSTIFIED APPROACH IN HEMATOLOGIC DISORDERS - PRELIMINARY-RESULTS OF A PROSPECTIVE MULTICENTER STUDY

The feasibility and safety of laparoscopic splenectomy were evaluated in a prospective multicenter study of 50 patients operated on for idio pathic thrombocytopenic purpura (ITP) (n=31), hereditary spherocytosis (n=6), hemolytic anemia (n=4), Hodgkin's disease or lymphoma staging (n=5), benign splenic tumors (n=3), and wandering spleen (n=1), Conver sion to laparotomy was required in 10%. An accessory spleen was routin ely searched for, although the lesser sac was opened during surgery in only 10%; the overall incidence was 14%, Hospital mortality was 2% an d postoperative morbidity 22%, Postoperative hospital stay and home re habilitation were improved when exclusively laparoscopic splenectomy w as performed, In ITP patients, at a mean follow-up of 8.2 months, 8 pa tients (27%) had recurrence of thrombocytopenia, which was transient i n 7% and permanent in 20%, Laparoscopic splenectomy is feasible and sa fe when performed in selected patients by expert laparoscopic surgeons . Adequate selection of patients and routine, careful search for acces sory spleen are critical, The recurrence rate (20%) for ITP was high a t 8.2 months, and this factor is the major limitation of laparoscopic splenectomy at present.