title: Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen.
abstract: OBJECTIVE
  Idiopatic thrombocytopenic purpura (ITP) is the most common indication for splenectomy. The failure rate of surgery is about 8% and the failure rate after splenectomy is approximately 28% for all patients. When the presence of an accessory spleen is diagnosed, splenectomy is recommended. Laparoscopic approach is considered the first choice.
  
  
  METHODS
  At our Department, between July and November 2011 two patients underwent laparoscopic accessory splenectomy for recurrence of ITP. Both patients had a previously laparoscopic splenectomy. Preoperative Magnetic Resonance (MR) was performed in both the cases revealing the presence of an accessory spleen.
  
  
  RESULTS
  The operative time was 105 and 100 minutes respectively. No perioperative complications occured. Hospital stay was four days in both cases. The first patient had a disease free period of two months; the second one of one month. Both patients restarted immunosuppressive therapy.
  
  
  CONCLUSIONS
  The relapse of thrombocytopenia post-splenectomy can be associated with the presence of an accessory spleen. The laparoscopic accessory splenectomy should be considered the first choice approach. Surgical accessory splenectomy allows a transitory remission of the disease.
authors.forename: C A
authors.initials: CA
authors.lastname: Leo
authors.forename: R
authors.initials: R
authors.lastname: Pravisani
authors.forename: S
authors.initials: S
authors.lastname: Bidinost
authors.forename: U
authors.initials: U
authors.lastname: Baccarani
authors.forename: V
authors.initials: V
authors.lastname: Bresadola
authors.forename: A
authors.initials: A
authors.lastname: Risaliti
authors.forename: G
authors.initials: G
authors.lastname: Terrosu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D011182:Postoperative Care; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013154:Spleen / Q000002:abnormalities* / Q000601:surgery; D013156:Splenectomy / Q000379:methods; D016896:Treatment Outcome