title: Long-term results after splenectomy in adult idiopathic thrombocytopenic purpura: comparison between open and laparoscopic procedures.
abstract: BACKGROUND
  Only a few studies have addressed long-term results comparing laparoscopic and open splenectomy in idiopathic thrombocytopenic purpura (ITP). We analyzed the 1-year results comparing age, sex, length of preoperative steroid therapy, diagnosis-to-splenectomy interval, and preoperative platelet count in relation to postoperative response after open and laparoscopic splenectomy.
  
  
  METHODS
  Data collected from two groups, treated by laparoscopic and open splenectomy, respectively, of 20 patients each were retrospectively reviewed. Positive response to splenectomies, evaluated according to the International Working Group guidelines reported by the American Society of Hematology, was statistically related through Student's t test and the Pearson correlation test to the above-mentioned factors.
  
  
  RESULTS
  Positive response to splenectomy was observed in 80% and 85% of patients, respectively, in the laparoscopic and open groups (P > .10). No statistical differences were observed comparing each of the studied factors between laparoscopic and open splenectomy responder patients (P > .10). When percentage increase of postoperative platelet count was related to diagnosis-to-splenectomy interval, a positive correlation was found in the laparoscopic group (r = 0.544, P < .05). In addition, a significant negative correlation in both groups was observed comparing preoperative platelet count and percentage postoperative platelet increase, with a greater increase of postoperative platelet count in patients with a lower preoperative platelet count (laparoscopic group, r = -0.663; open group, r = -0.656; P < .01).
  
  
  CONCLUSIONS
  In this series long-term results after laparoscopic splenectomy in ITP patients were as effective as after the open approach. Higher postoperative platelet percentage increase was achieved in both groups in patients with a lower preoperative platelet count. Finally, laparoscopic splenectomy in this study seems to be superior to the open approach in patients with a longer diagnosis-to-splenectomy interval.
authors.affiliation: Laparoscopic Surgery Unit, Department of Surgery, University of Catania, Polyclinico - Vittorio Emanuele University Hospital, Catania, Italy. rvecchio@unict.it
authors.forename: Rosario
authors.initials: R
authors.lastname: Vecchio
authors.forename: Salvatore
authors.initials: S
authors.lastname: Marchese
authors.forename: Eva
authors.initials: E
authors.lastname: Intagliata
authors.forename: Ehab
authors.initials: E
authors.lastname: Swehli
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferla
authors.forename: Emma
authors.initials: E
authors.lastname: Cacciola
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult