ADVANTAGES OF LAPAROSCOPIC SPLENECTOMY FOR SPLENOMEGALY DUE TO HEMATOLOGIC DISEASES

Recent advancements in laparoscopic surgery have made laparoscopic spl enectomy possible. We retrospectively compared the outcomes of laparos copic vel sus open splenectomy in patients with idiopathic thrombocyto penic purpura (ITP) or beta-thalassemia. From July 1993 to July 1997, 52 patients (ITP, 43 cases; beta-thalassemia, 9 cases) underwent eithe r laparoscopic (30 patients, 9 men, 21 women; average age, 36.9 years) or conventional open splenectomy (22 patients, 5 men, 17 women: avera ge age, 34.3 years). The two groups were similar in terms of sex, age, diagnosis, duration of disease, preoperative platelet count, and sple en size. The mean surgical time, estimated amount of blood loss, durat ion of postoperative recovery, analgesic usage, and complications were compared between the two groups. Laparoscopic splenectomy was success ful in 29 (97%) of the 30 patients. The mean surgical time in the lapa roscopy group was longer than in the open splenectomy group (190.6 vs 113.9 minutes, p < 0.01). The laparoscopy group had earlier postoperat ive oral intake (15.2 vs 52.6 hours, p < 0.01), less usage of analgesi cs (meperidine 50 mg/unit, 1.1 vs 2.8 units, p < 0.01) and a shorter p ostoperative hospital stay (4.1 vs 6.8 days, p < 0.01). The estimated blood loss, incidence of accessory, spleen, surgical complication rate , and recurrence rate of thrombocytopenia were similar in the two grou ps. Our findings show that laparoscopic splenectomy in patients with I TP or beta-thalassemia is as safe as the open approach. While laparosc opy required a longer surgical time, the recovery period was shorter, analgesic use was less, and physical discomfort was less severe.