LAPAROSCOPIC VERSUS OPEN SPLENECTOMY FOR IMMUNE THROMBOCYTOPENIC PURPURA

Background. We sought to determine whether laparoscopic techniques can reduce the operative morbidity of surgery in patients undergoing sple nectomy for immune thrombocytopenic purpura (ITP). Methods. All patien ts (60) undergoing splenectomy for ITP at the Royal Adelaide Hospital from January 1985 to November 1995 were reviewed. Results of patients undergoing open operation were obtained by means of retrospective case note review, whereas details of all patients undergoing laparoscopic splenectomy were collected prospectively and maintained on a computeri zed database. Results. Forty-seven patients underwent splenectomy with an open technique and 13 with a laparoscopic technique. Patient group s were demographically similar. All laparoscopic procedures were compl eted with the laparoscopic technique. An accessory spleen was also rem oved at laparoscopic operation from two (15%) patients and at open ope ration from three patients (6%). Two more accessory spleens were misse d at the original procedure, one at open operation and one at laparosc opic operation. These required later removal by using open and laparos copic techniques, respectively. Blood and platelet transfusion require ments were reduced by the laparoscopic approach. Although mean operati ng times were similar (87 versus 88 minutes), laparoscopic splenectomy was associated with a greatly reduced postoperative hospital stay (10 versus 2 days, median; p < 0.0001) and no major morbidity. Long-term normalization of platelet counts was similar for the two techniques. T he laparoscopic approach resulted in a reduction in hospital treatment costs from $4224 to $2238 per case (cost savings of $1986 per case). Conclusions. Laparoscopic splenectomy results in improved clinical out comes and reduced costs for patients undergoing elective splenectomy f or ITP.