Laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP) - Afive-year experience

Background: Laparoscopic splenectomy (LS) has rapidly become the preferred surgical treatment for idiopathic thrombocytopenic purpura (ITP), but its l ong-term efficacy for this disorder is unproved. This report documents the author's 5-year experience with, and long-term follow-up of, LS for ITP. Methods: Between September 1992 and September 1997, 30 patients with clinic al ITP and intractable thrombocytopenia were referred as surgical candidate s. Two of them (7%) were converted to open, and the other 28 underwent succ essful LS. The operative approach evolved from a supine lithotomy to right lateral decubitus position, and the harmonic scalpel became the primary dis section tool in the later part of the study. Results: The 28 successful LS patients constituted the study group. Accesso ry spleens were identified and resected in six patients (21%). Surgical tim es and blood loss averaged 2.4 h and 170 cc, respectively. The typical hosp ital stay was 2 days. Initial reversal of thrombocytopenia and ultimate ces sation of oral steroids was achieved in 25 of 28 patients (89%). There were no deaths, but two patients had major complications (bleeding and pneumoni a). All but two patients experienced a return to full activity and/or emplo yment by 3 weeks post-LS. In the three cases that failed LS, none had resid ual splenic tissue on subsequent radionuclide scan. Long-term follow-up (2- 60 months) was obtained in 22 of 28 patients (79%). The only death (at 13 m onths) resulted from oncologic disease. Twenty-one patients had lasting cli nical remission of ITP. A positive preoperative response to oral steroids w as the best predictor of success. Conclusions: This 5-year experience with LS supports its use for the surgic al treatment of ITP. The procedure is safe and efficacious, resulting in br ief hospitalization, minimal recovery time, and excellent long-term results .