Laparoscopic versus open splenectomy for immune thrombocytopenic purpura

• Published in: The American journal of surgery Vol. 176; no. 4; pp. 366 - 369
• Main Authors: Lozano-Salazar, Rubén R, Herrera, Miguel F, Vargas-Vorácková, Florencia, López-Karpovitch, Xavier
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.1998; Elsevier; Elsevier Limited
• Subjects: Abdomen; Adult; Biological and medical sciences; Blood platelets; Cohort Studies; Complications; Female; Hemorrhage; Humans; Laparoscopy; Laparotomy; Length of Stay; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Patients; Purpura; Purpura, Thrombocytopenic - immunology; Purpura, Thrombocytopenic - surgery; Retrospective Studies; Spleen; Splenectomy; Splenectomy - methods; Steroids; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgical techniques; Thrombocytopenia; Thrombocytopenic purpura; Treatment Outcome; Human; Endoscopic surgery; Immunopathology; Hemopathy; Laparoscopy; Method; Splenectomy; Platelet; Treatment; Efficiency; Surgery; Cohort study; Abdominal route; Safety; Immune thrombocytopenic purpura; Comparative study
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(98)00209-8

Background: Laparoscopic splenectomy (LS) has been proposed as a substitute to open splenectomy (OS) in the treatment of immune thrombocytopenic purpura (ITP). The aim of this study was to compare two cohorts of patients with ITP who underwent OS or LS. Patients and Methods: From February 1990 to January 1997, 27 patients underwent OS and 22 LS. Perioperative characteristics, outcomes, and complications were comparatively analyzed. Results: Mean age was 38 years (± 16) in the OS group, and 39 (± 16) in the LS group; the male:female ratio was 1:2 in both groups. Median preoperative platelet count was 16 × 10 9/L (range 2 to 186 × 10 9/L) in the OS group, and 50 × 10 9/L (2 to 241 × 10 9/L) in the LS group. Mean operative time was 2.7 hours (± 0.7) for OS, and 4.5 hours (± 1) for LS ( P <0.0001). Two conversions to laparotomy occurred in the LS group. A total of 14 complications occurred in 10 patients of the OS group; 8 complications occurred in 6 patients 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 group and 4 days (2 to 11) in the LS group ( P <0.02). Response rates were similar in both groups. Conclusions: Laparoscopic splenectomy is comparable to OS in terms of efficacy and safety, and it is associated with a shorter hospital stay.