Laparoscopic splenectomy and the treatment outcomes for idiopathic thrombocytopaenic purpura at North Shore Hospital.
OBJECTIVE
Firstly, the demographics of laparoscopic splenectomy cases at North Shore Hospital (Takapuna, Auckland, New Zealand), the outcomes of operative technique, and perioperative complications by a single surgeon were reviewed. Secondly, analysis was performed on patients with idiopathic thrombocytopaenic purpura (ITP) with regard to platelet response and detection of preoperative predictors.


METHODS
Laparoscopic splenectomy patients from 1998 to 2007 were reviewed with respect to demographics, operation and their complications. ITP outcomes, analysed separately, were categorised as complete remission for postsplenectomy platelet counts greater than 150 x 10(9)/L, partial remission as 30 - 149 x 10(9)/L and refractory as platelet counts less than 30 x 10(9)/L. The relationships between preoperative steroid, immunoglobulin transfusion and operative outcomes were analysed.


RESULTS
29 (67%) out of 43 laparoscopic splenectomies were for ITP. For ITP cases, 19 (65%) achieved complete remission and six (21%) partial remission at 3-month follow-up. Follow-up detected that two cases in each group had relapses after 3 months. Explorative data analysis suggested that a lack of preoperative transfusion may predict an approximately 80% chance of complete remission postsplenectomy. There was one conversion to an open splenectomy and no mortality with minimal complications.


CONCLUSIONS
Cumulatively, in 86% of cases, laparoscopic splenectomy created a significant increase in platelet counts at 3-month postoperatively without any long-term morbidity. Although not strongly demonstrated, preoperative immunoglobulin transfusion may be correlated with remission.
Prasad
Shalvin
S
Department of General Surgery, North Shore Hospital, Takapuna, Auckland, New Zealand. dr.sprasad@gmail.com
Harman
Richard
R
Henderson
Ross
R
Chunnilal
Sanjeev
S
Simpson
David
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010976:Platelet Count; D011183:Postoperative Complications / Q000453:epidemiology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000453:epidemiology / Q000208:ethnology / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome