Laparoscopic splenectomy reduces the need for platelet transfusion in patients with idiopathic thrombocytopenic purpura.
OBJECTIVE
Laparoscopic splenectomy has been increasingly used in patients with idiopathic thrombocytopenic purpura. Because it is associated with minimal abdominal trauma, platelet consumption could be reduced with the laparoscopic approach. The aim of this study was to analyze intraoperative bleeding and the need for apheresis platelets, comparing laparoscopic with open splenectomy.


METHODS
Records of 40 patients who underwent splenectomy (20 through laparoscopy and 20 through open surgery) for idiopathic thrombocytopenic purpura were retrospectively reviewed. Intraoperative bleeding and need of perioperative apheresis platelets were evaluated in both groups. Statistical evaluation was conducted using the Mann-Whitney rank test, and differences were considered significant at P<0.01.


RESULTS
The mean amount of intraoperative bleeding was less in the laparoscopic group (P<0.01). Apheresis platelets were necessary in all patients in the open group (2 units transfused in 55% and 1 unit in 45% of cases) and only in 30% of cases in the laparoscopic group (1 unit transfused in each case).


CONCLUSIONS
Laparoscopic splenectomy is a safe procedure also in patients at high risk for bleeding diathesis. In idiopathic thrombocytopenic purpura, laparoscopic splenectomy should be the gold-standard surgical treatment. Need of platelet transfusion is probably reduced when laparoscopic splenectomy is compared with open surgery in these patients.
Vecchio
Rosario
R
University of Catania, Department of Surgery, Vittorio Emanuele Hospital, Italy. rvecchio@unict.it
Cacciola
Emma
E
Lipari
Giuseppe
G
Privitera
Valeria
V
Polino
Chiara
C
Cacciola
Rossella
R
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D017713:Platelet Transfusion; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*