Impact of hematological diagnosis on early and late outcome after laparoscopic splenectomy - An analysis of 111 cases

Background: Laparoscopic splenectomy (LS) is now regarded as the treatment of choice for autoimmune thrombopenia (ITP). However, there have been few r eports describing the application of LS to other splenic diseases, such as malignant entities and conditions associated with splenomegaly. Hematologic al diseases have specific clinical features that can influence immediate ou tcome after LS. Although the long-term effects of LS are unknown, a risk of splenosis has been suggested. Therefore, we designed a study to analyze th e impact of primary hematological disease on immediate and late outcome in a prospective series of LS patients. Methods: We performed a prospective analysis of 111 LS done between Februar y 1993 and March 1999. The patients were classified by hematological indica tions into the following four groups: (a) group 1, low platelet count. This group was further subdivided into group 1A, idiopathic thrombocytopenic pu rpura (ITP) (n = 48) and group 1B, HIV-related ITP (n = 8); (b) group 2, an emia. This group was further subdivided into group 2A, autoimmune hemolytic anemia (n = 8), and group 2B, spherocytosis (n = 11); (c) group 3, maligna ncy (n = 28); and (d) group 4, others (n = 8). Immediate outcomes were reco rded prospectively. Hematological status and late complications were review ed after a mean follow-up of 24 +/- 18 months. Results: There were no significant differences between the groups in terms of conversion, transfusion requirements, and morbidity, although transfusio n and morbidity were slightly higher in group 3. However, hospital stay was significantly longer in groups 3 and 4 than in groups I and 2. Long-term f ollow-up showed satisfactory hematological re-suits in greater than or equa l to 75% of patients (group 1A, 82%; group 1B, 88%; group 2A, 88%; group 2B , 100%; group 3, 75%; group 4, 88%). Overall, late morbidity was 8.3% and m ortality was 6.2%, mainly due to deaths in group 4 (six of 22 patients). Conclusion: LS is a safe and reproducible procedure for most hematological indications, with a similar immediate outcome for benign diseases and a lon g-term hematological response comparable to the standard results that have been observed in open series.