LAPAROSCOPIC VERSUS OPEN SPLENECTOMY FOR IMMUNE THROMBOCYTOPENIC PURPURA

BACKGROUND: Laparoscopic splenectomy (LS) has been proposed as a subst itute to open splenectomy (OS) in the treatment of immune thrombocytop enic purpura (ITP). The aim of this study was to compare two cohorts o f patients with ITP who underwent OS or LS. PATIENTS AND METHODS: From February 1990 to January 1997, 27 patients underwent OS and 22 LS. Pe rioperative characteristics, outcomes, and complications were comparat ively analyzed. RESULTS: Mean age was 38 years (+/- 16) in the OS grou p, and 39 (+/- 16) in the LS group; the male: female ratio was 1:2 in both groups. Median preoperative platelet count was 16 x 10(9)/L (rang e 2 to 186 x 10(9)/L) in the OS group, and 50 x 10(9)/L (2 to 241 x 10 (9)/L) in the LS group. Mean operative time was 2.7 hours (+/- 0.7) fo r OS, and 4.5 hours (+/- 1) for LS (P <0.0001). Two conversions to lap arotomy occurred in the LS group. A total of 1.4 complications occurre d in 10 patients of the OS group; 8 complications occurred in 6 patien ts of the LS group. Two patients died in the OS group and 1 in the LS group. mean postoperative discharge was 6 days (3 to 44) in the OS gro up and 4 days (2 to II) in the LS group (P <0.02). Response rates were similar in both groups, CONCLUSIONS: Laparoscopic splenectomy is comp arable to OS in terms of efficacy and safety, and it is associated wit h a shorter hospital stay. (C) 1998 by Excerpta Medica, Inc.