Results of laparoscopic splenectomy for immune thrombocytopenic purpura.
OBJECTIVE
To study the safety and efficacy of Laparoscopic Splenectomy (LS) for Immune Thrombocytopenic Purpura (ITP).


METHODS
Twenty-five consecutive adult patients with chronic ITP who did not achieve sustained remission or refractory to medical treatment underwent elective LS between March 1995 and July 2005. The perioperative course was documented and the follow up data were recorded.


RESULTS
All 25 patients underwent successful LS by a single surgeon. Twenty patients were available to analyze with a median follow-up time of 739 days (range, 18-3,555). The mean age was 29.8 years (range, 15-44) and 17 patients were female. The median preoperative platetlet count was 16,500/microL (range, 2,000-180,000). Accessory Spleens (AS) were removed in three patients (15%). A female patient died 24 days after LS from fungal brain abscesses. Fifteen patients (75%) had platelet count > 100,000/microL at initial response. Thirteen patients (65%) are in Complete Remission (CR) (platelet count > 100,000/microL). The probability of staying in CR after LS was 60.2% by Kaplan-Meier analysis. All failures occurred within 218 days of the operation. The mean age of the patients with CR was 27.2 years (range, 15-43) while the mean age of the nonCR was 34.7 years (range, 21-44).


CONCLUSIONS
LS should be considered as a safe and effective therapy when elective splenectomy is indicated for chronic ITP patients.
Mahatharadol
Virachai
V
Department of Surgery, Rajavithi Hospital, Bangkok, Thailand. virachaim@hotmail.com
Meesiri
Somchai
S
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D018450:Disease Progression; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D011446:Prospective Studies; D011696:Purpura, Thrombocytopenic / Q000276:immunology / Q000601:surgery*; D018570:Risk Assessment; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome