Laparoscopic splenectomy for idiopathic thrombocytopenic purpura

Wu, Jiann-Ming; Lai, I-Rue; Yuan, Ray-Hwang; Yu, Sen-Chang

doi:10.1016/j.amjsurg.2003.11.032

« Previous Next »The American Journal of Surgery
Volume 187, Issue 6 , Pages 720-723, June 2004

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura

Jiann-Ming Wu, M.D.
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-shan S. Road, Taipei, Taiwan 100, People's Republic of China
- Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan, People's Republic of China
I-Rue Lai, M.D.
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-shan S. Road, Taipei, Taiwan 100, People's Republic of China
Ray-Hwang Yuan, M.D.
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-shan S. Road, Taipei, Taiwan 100, People's Republic of China
Sen-Chang Yu, M.D.
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-shan S. Road, Taipei, Taiwan 100, People's Republic of China
- Corresponding author. Tel.: + 886-2-2312-3456; fax: + 886-2-2394-9675

Received 23 May 2003; received in revised form 11 November 2003

Abstract

Background

Laparoscopic splenectomy (LS) has become the treatment of choice for patients with idiopathic thrombocytopenic purpura (ITP) who do not respond to medical treatment. Long-term follow-up data of LS for ITP are scarce.

Methods

From May 1997 to December 2002, we performed 67 LS for patients with ITP. Data were assessed retrospectively.

Results

LS was successfully attempted in all 67 patients. There was no surgical mortality. Three postoperative complications (5%) were encountered. The mean operative time decreased significantly from 176.2 minutes in the first 41 cases to 125.2 minutes in the last 26 cases. The mean postoperative hospital stay was 3.2 days. Accessory spleens were found in 3 patients (5%) during the LS. The mean follow-up interval was 23.3 months. The initial response to LS was 83%, and overall remission of ITP was 74%. The preoperative effect of steroid therapy had no significant influence on postoperative remission rate. More significant indicators of LS effectiveness were either an immediate postoperative platelet count surge or an immediate postoperative platelet count ≥100,000/μL.

Conclusions

LS can be performed safely with a satisfactory remission rate for patients with ITP who do not respond to medical treatment. Our results indicated that an immediate postoperative platelet count surge and/or an immediate postoperative platelet count ≥100,000/μL were positive predictors of long-term remission after LS for ITP.

Keywords: Idiopathic thrombocytopenic purpura, Laparoscopy, Splenectomy