LAPAROSCOPIC SPLENECTOMY FOR IMMUNE THROMBOCYTOPENIC PURPURA

Objective: To evaluate laparoscopic splenectomy as a treatment of immu ne thrombocytopenic purpura (ITP). Design: Retrospective review of 18 patients followed up from 1 to 30 months. Setting: Referral center usi ng community hospital. Patients: Consecutive series of patients underg oing laparoscopic splenectomy for ITP. Intervention: Laparoscopic sple nectomy. Main Outcome Measure: Surgical and hematologic results. Resul ts: Eighteen patients underwent laparoscopic splenectomy for ITP. All procedures were completed laparoscopically. There was no perioperative mortality. Pancreatitis developed in 1 patient (6%); 17 (94%) of 18 p atients responded to splenectomy. The mean platelet count increased fr om 29x10(9) to 461x10(9)/L after laparoscopic splenectomy and stabiliz ed at 327x10(9)/L (mean follow-up period, 15 months). Mean (+/-SEM) op erative blood loss was 214+/-52 mt, necessitating no transfusions. Mea n hospital stay was 2 days (range, 1-7 days). Most patients tolerated a liquid diet the day of the operation and a solid diet the next day. Parenteral narcotic usage averaged 12.3 morphine equivalent units, and 6 patients (33%) required no parenteral analgesia. An accessory splee n was identified in 1 patient (6%). Mean (+/-SEM) operative time was 1 30+/-8 minutes and was significantly less in the second half of our ex perience (117 vs 144 minutes, P=.04). Conclusions: Laparoscopic splene ctomy is safe and effective for the management of ITP and allows rapid recovery. With increasing experience, operative times decrease. Lapar oscopic splenectomy should be the treatment of choice for patients wit h ITP who require splenectomy.