title: Chronic idiopathic thrombocytopenic purpura (ITP) is a surgical disease.
abstract: BACKGROUND
  We designed a study to assess the safety and long-term efficacy of laparoscopic splenectomy (LS) for the treatment of chronic idiopathic thrombocytopenic purpura (ITP).
  
  
  METHODS
  Over a period of 55 months, 104 patients underwent LS for chronic ITP. The perioperative course was documented and the long-term follow-up data were recorded.
  
  
  RESULTS
  The mean age was 36.9 years (range, 8-83) and 72 patients were female. Patients were operated on with a mean platelet count of 110,000/ml. Fifty-one patients were operated on with a platelet count of < 100,000; 18 of them had a count of < 50,000/ml and 11 had a count of < 10,000/ml. There were no conversions to laparotomy. Bleeding occurred in 14 patients, and five of them received a blood transfusion. The mean operating time was 56.5 min (range, 25-240). There were minor complications in five patients and major complications in three. The mean hospital stay was 2.1 days (range, 0-13). Over a mean follow-up period of 36 months (range, 4-62), all but four patients were available for follow-up. Eighty-four patients are in complete remission. Seven patients are in partial remission, with a platelet count of 50,000-100,000 \ml without medical treatment. Eleven patients did not respond or relapsed following a short initial response; three of them underwent later removal of an accessory spleen, two with partial response. All but two relapses occurred within 70 days of the operation.
  
  
  CONCLUSIONS
  LS is safe and effective for the treatment of chronic ITP and yields excellent long-term results. Until another form of treatment emerges, LS should be considered the treatment of choice for this disease and recommended to the patient at an early stage of the disease.
authors.affiliation: Endoscopic Surgery Service, Department of Surgery B, Tel Aviv Sourasky Medical Center and the Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 64239, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Szold
authors.forename: H
authors.initials: H
authors.lastname: Kais
authors.forename: A
authors.initials: A
authors.lastname: Keidar
authors.forename: L
authors.initials: L
authors.lastname: Nadav
authors.forename: A
authors.initials: A
authors.lastname: Eldor
authors.forename: J M
authors.initials: JM
authors.lastname: Klausner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D013156:Splenectomy / Q000379:methods