Laparoscopic splenectomy for idiopathic thrombocytopenic purpura

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 >or=100000/microL. 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 >or=100000/microL were positive predictors of long-term remission after LS for ITP.     

Laparoscopic splenectomy

PURPOSE: To study the safety and efficacy of laparoscopic splenectomy (LS) in patients with hematologic disorders requiring surgical intervention. PATIENTS AND METHODS: A series of 103 consecutive adult patients underwent LS between 1992 and 1997 at our teaching hospital. Data were collected prospectively. The indications for splenectomy included idiopathic thrombocytopenic purpura (ITP), hereditary spherocytosis, autoimmune hemolytic anemia, and thrombotic thrombocytopenic purpura. RESULTS: The mean spleen size was 14 cm (range 8.5-24 cm) and the mean weight was 263 g (range 40-210 g). Accessory spleens were detected in 12 patients with ITP and 17 patients in the study overall. In 12 patients, LS was combined with a laparoscopic cholecystectomy for gallstones. There were four conversions to open splenectomy, all for hemorrhage and all occurred in the first 50 patients. We have not converted a single patient in the last 2 years. The mean operative time was 161 minutes and was greater in the first 10 cases than the last 10. There were no deaths. Postoperative complications occurred in six patients, one necessitating a second procedure for a small-bowel obstruction. The average length of stay in the hospital was 2.5 days. After surgery, thrombocytopenia resolved in 84% of patients with ITP and anemia resolved in 92% of the patients with hereditary spherocytosis. After a mean follow-up of 38 months (range 2-565 months), four patients (6%) showed a relapse of ITP, three within 12 months of surgery. CONCLUSIONS: Laparoscopic splenectomy can be performed safely and effectively in a teaching institution. LS in comparison with open surgery offers the same efficacy in the control of hematologic disease with the additional benefits of a minimally invasive approach. Laparoscopic splenectomy should therefore be considered the technique of choice and should prompt earlier consideration of surgery for patients with selected hematologic disorders.     

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura

Background: Laparoscopic splenectomy is a novel approach for the treatment of idiopathic thrombocytopenic purpura (ITP) in patients requiring surgical intervention. This technique was used for treatment in 16 consecutive patients. Follow-up was initiated at a median of 13.5 months after surgery to determine whether or not laparoscopic splenectomy is a safe and successful procedure that should be used in all patients requiring splenectomy for ITP. Methods: Sixteen patients underwent laparoscopic splenectomy for ITP between May 1994 and September 1996. They were evaluated prospectively prior to surgery, immediately following surgery, at discharge, and at 13.5 months following surgery (n= 14) to determine the short- and long-term results of the procedure. Results: Mean operation time was 123.4 ± 12.1 min, and there were no significant intra- or postoperative complications. Mean intraoperative blood loss was 437.5 ± 73.5 ml. Autologous blood transfusion was necessary in one patient (6.3%). Mean organ weight was 202.2 ± 47.3 g. Mean postoperative hospital stay was 4.6 ± 0.4 days. Before discharge, mean platelet count rose by 100.7%. At follow-up (13.5 months postoperatively), it was 77.7% above preoperative values. No additional surgery was necessary in any of the patients undergoing laparoscopic splenectomy, and hematologic success was achieved in 12 patients (85.7%). Conclusions: Our results clearly indicate that laparoscopic splenectomy is a safe and successful procedure in patients suffering from ITP. It offers the well-known advantages of minimal invasive surgery as well as the surgical effectiveness of the open approach. This surgical technique should therefore be considered in all patients requiring splenectomy for the treatment of ITP.     

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP)

Background: Although the short-term benefits of laparoscopic splenectomy (LS) have been well documented, long-term follow-up data of patients who have undergone LS for ITP are scarce. We report our long-term follow-up data in patients who underwent LS for idiopathic thrombocytopenic purpura (ITP). Methods: Data were obtained from a prospectively collected computer database of 52 patients who underwent LS between October 1992 and December 2000 for medically refractory ITP. Patients and their referring hematologist were contacted, and follow-up information was obtained for 45 patients. Results: Fifty-two patients (27 women and 25 men) underwent LS for ITP. Median operative time was 160 min (range, 70–335); and median blood loss was 100 cc (range, 20–1500). There were seven cases of intraoperative hemorrhage (13.7%), resulting in one conversion. A second case was converted due to inadequate working space in a patient with a 26-cm spleen. Accessory spleens were found in 17 patients (32.7%). Postoperative complications occurred in three patients (5.9%). There were no deaths. Median length of hospital stay was 2 days (range, 1–12). Follow-up data were obtained in 45 patients (86.5%), with a median follow-up of 51 months. Six patients did not respond to surgery initially, and another two patients developed recurrent disease, for a remission rate of 82.2%. Nine patients underwent a damaged red blood cell scan. This group included the two patients who suffered recurrences. A positive scan was obtained in three patients (33%), one of whom was a patient with recurrent disease. This patient underwent an uneventful laparoscopic excision of residual splenic tissue but continues to require intermittent steroids to maintain platelet counts. The two other patients with a positive scan remain in remission. Conclusions: Laparoscopic splenectomy for ITP is safe and associated with low morbidity and a short hospital stay. Long-term follow-up showed that remission rates of ITP following LS are comparable to those reported in the literature on open surgery.     

101 laparoscopic splenectomies for the treatment of benign and malignant hematologic disorders

BACKGROUND: Laparoscopic splenectomy (LS) is the surgical approach of choice for patients with hematologic disorders requiring splenectomy. Patients with idiopathic thrombocytopenic purpura (ITP) have normal to slightly enlarged spleens and benefit the most from LS. METHODS: We reviewed the perioperative outcomes in 101 patients who underwent LS between May 1996 and December 2002. Patients were divided into three groups--ITP, other benign, and malignant hematologic disorders--and compared. RESULTS: The ITP patients (n = 48) had significantly smaller spleens and operative times compared with the other groups. Splenomegaly in the other benign (n = 23) and malignant hematologic disorders (n = 30) groups was responsible for higher open conversion rates and greater need for hand-assisted laparoscopic splenectomy (HALS). CONCLUSIONS: Laparoscopic splenectomy and HALS can be performed with good results for benign and malignant hematologic disorders. The benefits of HALS are similar to LS, so there should be a low threshold for HALS in patients with large spleens.     

Laparoscopic accessory splenectomy for recurrent idiopathic thrombocytopenic purpura and hemolytic anemia

BACKGROUND: Laparoscopic splenectomy is an effective treatment for idiopathic thrombocytopenic purpura (ITP) and hemolytic anemia that has a remission rate of 80-90%. In some patients in whom the disease persists or recurs, a diagnosis of accessory spleen is made. The long-term efficacy of laparoscopic accessory splenectomy is unknown. METHODS: Patients who underwent laparoscopic accessory splenectomy were followed in the outpatient clinic. The perioperative course, blood counts, and need for medical therapy to maintain a normal count were recorded. RESULTS: Eight patients underwent laparoscopic accessory splenectomy. All procedures were completed laparoscopically, and all patients were discharged on the 1st postoperative day. Patients were available for a follow-up period of 15 months range, (3-27). None of the ITP patients achieved a complete remission. Two of them had a partial remission, and five ITP patients are now being treated with chronic corticosteroids to maintain a platelet count of >100,000/ml. CONCLUSION: Laparoscopic accessory splenectomy is associated with a low rate of morbidity and a short hospital stay. Despite its success in removing all residual splenic tissue, most patients will probably not enjoy a complete remission.     

Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura

HYPOTHESIS: Younger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS). DESIGN: Case series. SETTING: Private, tertiary care referral center. PATIENTS: Sixty-seven consecutive patients undergoing LS for ITP between 1995 and 2001. INTERVENTIONS: Laparoscopic splenectomy. MAIN OUTCOME MEASURES: A successful response to LS was defined as a postoperative platelet count greater than 100 x 10(3)/microL without medical therapy. Failures were classified as recurrent or refractory. Patients considered refractory to surgery did not achieve a platelet count greater than 100 x 10(3)/microL without medical therapy. Patients with recurrent ITP initially achieved a platelet count greater than 100 x 10(3)/microL, but thrombocytopenia subsequently recurred. RESULTS: Both univariate and multivariate analyses were performed for 13 preoperative variables to identify factors predictive of success following LS. At a mean follow up of 22 months, 43 patients (64%) had a successful response to LS, 14 (21%) were refractory, and 10 (15%) developed recurrent ITP. By univariate analysis, patients responding to laparoscopic splenectomy were younger (P =.005) and had a higher preoperative platelet count (P =.005). In multivariate analysis, younger age (P =.005) and a higher preoperative platelet count (P =.007) again predicted a successful response to LS. CONCLUSIONS: A successful response to LS for ITP is expected in patients younger than 50 years and in those with preoperative platelet counts greater than 70 x 10(3)/microL. These factors can be incorporated into an equation that yields a splenectomy prediction score, which predicts the success of LS for ITP.     

Splenectomy for idiopathic thrombocytopenic purpura

Background: This study aimed to compare the safety, efficacy, and clinical benefits of laparoscopic splenectomy (LS) to open splenectomy (OS) in patients with idiopathic thrombocytopenic purpura (ITP). Methods: The results from 14 consecutive patients who underwent LS for ITP were reviewed and compared with the results from patients who underwent OS for the same disease. Demographics, concomitant disease on admission, and platelet counts were evaluated, as were details of the surgical procedure, postoperative physiologic status, and hospital stay. Results: Mean operative time was 88.3 min for OS and 146.4 min in LS group (p < 0.05). The conversion rate to open splenectomy was 7.1. Therapeutic response to splenectomy was 92.8% in the LS group and 86.6% in the OS group. Bowel canalization, return to liquid diet, and length of hospital stay were all significantly delayed in the OS group as compared with those who underwent LS (p= 0.01, p= 0.02, p= 0.005, respectively). In the OS group the morbidity rate was 13.3%, whereas in the LS group it was 7.1%. Conclusions: Laparoscopic splenectomy represents a valid alternative to conventional splenectomy in the treatment of ITP. Received: 10 October 1997/Accepted: 11 March 1998     

Introduction of laparoscopic splenectomy for the treatment of immune thrombocytopenic purpura

AIM OF THE STUDY: Was to evaluate retrospectively the outcomes and efficacy of the laparoscopic splenectomies for ITP patients, performed at our institution over a period of 7 years and to compare these results with those after open splenectomies. PATIENTS AND METHODS: We collected and analyzed data of 22 consecutive adult patients with ITP who underwent either laparoscopic (LS gr., n = 9) or open (OS gr., n = 13) splenectomy at Hospital of Kaunas University of Medicine between the years 1996 and 2002. The indications for splenectomy in these patients were unsuccessful treatment with corticosteroids or other medications and/or the requirement of high dosages of steroids for prolonged periods of time to maintain platelet count > 50 G/L before operation. Prior to surgery, all patients were treated with corticosteroids and/or intravenous immunoglobulin to raise the platelet count and to minimize the risk of intraoperative bleeding. The efficacy of the operation was evaluated by counting platelets one day before surgery and on the first and fifth postoperative day. Data chosen for analysis included age, gender, weight, height, American Society of Anaesthesiologists (ASA) score, number of converted patients, estimated blood loss during operation, operating time, postoperative secretion through the drains, morbidity, mortality and postoperative hospital stay. RESULTS: There were no significant differences between LS and OS groups according patients age, weight, height, gender and ASA score. The mean operative time was 138.8 +/- 50.1 min in LS group and was significantly longer than operative time in OS group (102.3 +/- 21.3 min). One patient was converted to open splenectomy because of severe bleeding from splenic hilum. Postoperative complications occurred in one patient from each group. The mean intraoperative blood loss was 460 +/- 125 ml in LS group and 510 +/- 140 ml in OS group (p > 0.05). Postoperative secretion through the drains and postoperative secretion time in LS group was significantly lower and shorter than in OS group. Postoperative hospital stay in LS group (5 +/- 1.1 days) was significantly shorter than in OS group (8 +/- 1.4 days). After splenectomy, there was an immediate increase in the platelet count of all patients in both groups. Between the day before surgery and the first postoperative day, the mean platelet count rose significantly from 75 +/- 57.0 G/L to 117 +/- 84.2 G/L in LS group and from 64 +/- 60.1 G/L to 122 +/- 79.3 G/L in OS group. Between the first postoperative day and the fifth postoperative day, the mean platelet count also rose significantly in both groups: from 117 +/- 84.2 G/L to 259 +/- 151.0 G/L in LS group and from 122 +/- 79.3 G/L to 258 +/- 158.4 G/L in OS group. In the immediate postoperative period (five days after operation), all LS group and OS group patients responded to the splenectomy. CONCLUSIONS: Laparoscopic or open splenectomy are equally efficacious in patients with ITP, with an immediate response rate of 100 % in our study. Our study results show that open splenectomy appears superior to laparoscopic procedure in terms of shorter operative time. Laparoscopic splenectomy appears superior to open procedure in terms of postoperative hospital stay, postoperative drainage time, less postoperative secretion through the drains. These two approaches are similar with regard to blood loss during operations and the rate of postoperative complications.     

Accessory spleens--diagnostic and therapeutic problem of the laparoscopic splenectomy in idiopathic thrombocytopenic purpura patients

The preoperative detection of accessory spleens (AS) is essential in ITP patients. The aim of this study was to evaluate the reasons of failure and long-term results of laparoscopic splenectomy (LS) in patients with idiopathic thrombocytopenic purpura (ITP). Thirty-four ITP patients (27 females and 7 males) underwent LS between June 1998 and January 2001. Computed Tomography (CT) and sonography (US) were performed preoperatively to evaluate the size of the spleen and to detect the presence of possible accessory spleens which were found in two cases. AS were seen during laparoscopy in three cases. During follow-up (median time = 23 months), in three patients a low platelet count was seen after 5 months, 1.5 and 1.8 years pop. In all these cases scintigraphy was performed, which revealed in one case the residual accessory spleen. In the two other patients, inspite of thrombocytopenia no residual spleens were found. The authors conclude that laparoscopic splenectomy is a safe and effective procedure in patients with ITP. The problem of accessory spleens can be managed by careful videoscopic examination of the abdominal cavity during splenectomy. The use of the preoperative imaging techniques for detection of accessory spleens is limited by the insufficient sensitivity of the examination.     

腹腔镜脾切除治疗特发性血小板减少性紫癜疗效及观测指标

目的：探讨腹腔镜脾切除(LS)治疗特发血小板减少性紫癜（ITP）的疗效。
方法：回顾分析采用腹腔境行脾切除治疗25例ITP患者的临床资料。
结果：所有ITP患者顺利施行LS,包括2例辅助小切口LS,无手术死亡、感染等严重并发症。平均随访3.5年（1～7年）,脾切除术后有效率80.0%（20/25例）,2年有效率72.0%（18/25例）,其中包括2例激素治疗出现胃溃疡大出血导致重度贫血及激素副作用的ITP患者。分析显示脾切除效果与患者年龄有关,≤50岁脾切效果明显优于>50岁的患者(P＜0.05)。术后随访发现脾切术后第7天血小板计数与术后2年复查血小板计数相一致,术后第7天平均血小板计数在脾切除有效者为307×109/L,明显高于脾切除无效的103×109/L（P＜0.05）。患者病程、激素治疗是否敏感、术前血小板计数均与脾切除疗效无关（P>0.05）。
结论：腹腔镜脾切除治疗特发性血小板减少性紫癜安全、可行并且有效,对年龄小于50岁、激素治疗无效或需大剂量激素治疗ITP患者宜积极行腹腔境脾切除术;脾切除时患者年龄、术后第7天血小板计数可能是判断脾切除效疗的有用指标。     

Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients.

OBJECTIVE: To study the safety and efficacy of laparoscopic splenectomy (LS) in patients with predominantly benign hematologic disorders. SUMMARY BACKGROUND DATA: The technical feasibility of LS has been recently established. However, data regarding the efficacy of the procedure in a large cohort of patients are scarce. METHODS: One hundred three consecutive patients underwent LS between June 1992 and October 1997. Data were collected prospectively on all patients. RESULTS: Indications were idiopathic thrombocytopenic purpura (ITP), hereditary spherocytosis, autoimmune hemolytic anemia, thrombotic thrombocytopenic purpura, and others. Mean spleen size was 14 cm and mean weight was 263 g. Accessory spleens were found in 12 patients with ITP and in 5 patients without ITP. There were no deaths. Complications occurred in six patients, one requiring a second procedure for small bowel obstruction. Six patients received transfusions, and four procedures were converted to open splenectomy for bleeding. Mean surgical time was 161 minutes and was greater in the first 10 cases than the last 10. Mean postsurgical stay was 2.5 days. Thrombocytopenia resolved after surgery in 84% of patients with ITP, and hematocrit levels increased significantly in 70% of patients with chronic hemolytic anemias. A positive response was noted in 92% of patients with hereditary spherocytosis, without relapse for the duration of the observation. ITP relapsed in four patients during follow-up, three within 12 months. CONCLUSIONS: LS can be performed safely and effectively in a teaching institution. Rigorous technique will minimize capsular fractures, reducing the risk of splenosis. Accessory spleens can be successfully localized, thus improving response and limiting recurrence of ITP. LS should become the technique of choice for treatment of intractable benign hematologic disease.     

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP)

Background: Laparoscopic splenectomy (LS) has rapidly become the preferred surgical treatment for idiopathic thrombocytopenic purpura (ITP), but its long-term efficacy for this disorder is unproved. This report documents the author's 5-year experience with, and long-term follow-up of, LS for ITP. Methods: Between September 1992 and September 1997, 30 patients with clinical ITP and intractable thrombocytopenia were referred as surgical candidates. Two of them (7%) were converted to open, and the other 28 underwent successful LS. The operative approach evolved from a supine lithotomy to right lateral decubitus position, and the harmonic scalpel became the primary dissection tool in the later part of the study. Results: The 28 successful LS patients constituted the study group. Accessory spleens were identified and resected in six patients (21%). Surgical times and blood loss averaged 2.4 h and 170 cc, respectively. The typical hospital stay was 2 days. Initial reversal of thrombocytopenia and ultimate cessation of oral steroids was achieved in 25 of 28 patients (89%). There were no deaths, but two patients had major complications (bleeding and pneumonia). All but two patients experienced a return to full activity and/or employment by 3 weeks post-LS. In the three cases that failed LS, none had residual splenic tissue on subsequent radionuclide scan. Long-term follow-up (2–60 months) was obtained in 22 of 28 patients (79%). The only death (at 13 months) resulted from oncologic disease. Twenty-one patients had lasting clinical remission of ITP. A positive preoperative response to oral steroids was the best predictor of success. Conclusions: This 5-year experience with LS supports its use for the surgical treatment of ITP. The procedure is safe and efficacious, resulting in brief hospitalization, minimal recovery time, and excellent long-term results. Received: 11 October 1998/Accepted: 19 February 1999     

Hematological long-term results of laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura: a case control study

Background Laparoscopic splenectomy (LS) for idiopathic thrombocytopenic purpura (ITP) appears, when compared to open splenectomy (OS), associated with immediate important advantages. However, in a number of patients splenectomy does not lead to an adequate response, or after initial adequate response a relapse occurs after some time. A relapse may be associated to the presence of accessory spleens and splenosis. The purpose of this study was to compare the operative outcome and the hematological results on the long term of a series of LS with a historic series of OS for the treatment of ITP.Methods A retrospective review was done of 50 consecutive patients who underwent LS for ITP. Patient characteristics, outcome of surgery, and hematological results were compared to a historical group of patients who underwent conventional splenectomy for ITP (n = 31). Response to splenectomy was defined in three groups: complete remission, partial remission, and no response. Grouping was based on hematological data.Results Concerning operative outcome and postoperative complications, there was a significant difference in favor of LS. Moreover, the hematological outcome of both groups showed no differences after a median period of 66 months (OS) and 35 months (LS), respectively.Conclusions Hematological results after laparoscopic splenectomy for ITP are comparable to those after open splenectomy in both the short and the long term.     

Are the favorable outcomes of splenectomy predictable inpatients with idiopathic thrombocytopenic purpura (ITP)?

BACKGROUND: Historically, splenectomy has been an accepted procedure in the management of immune thrombocytopenic purpura (ITP). However, it is also true that the response to splenectomy in patients with ITP seems to be unpredictable. Therefore, the purpose of this study was to identify clinical variables that might predict a favorable response to splenectomy in patients with ITP. METHODS: Data were collected retrospectively for 40 adult patients with ITP who underwent laparoscopic (LS) and open (OS) splenectomy at Emory University Hospital between 1992 and 1999. Demographics and outcomes were recorded. Age, sex, disease duration, comorbidities (ASA > 2), previous response to steroids and/or other medications, and preoperative platelet count were analyzed by univariate (t-test, Fisher's exact test) and multivariate statistical methods. RESULTS: Of the 20 patients in each group, improved platelet counts were noted in 18 patients (90%) in the LS group and 20 patients (100%) in the OS group. Follow-up (16 +/- 3 months) was obtained in 19 LS patients (95%) and 16 OS patients (80%), with 84% and 87.5% sustained response rates, respectively. After univariate analysis, two variables (age and disease duration) were found to be significantly related to the outcome of splenectomy (p 相似文献   

腹腔镜脾切除术治疗免疫性血小板减少性紫癜的学习曲线

目的评估腹腔镜脾切除术（LS）治疗免疫性血小板减少性紫癜（ITP）不同阶段的手术效果,探讨LS的学习曲线问题。方法回顾性分析2003年5月至2010年3月期间同一主刀医生完成的105例LS治疗ITP的临床资料。按入院顺序分为A、B、C3组,每组35例,比较3组手术时间、术中出血量、术后48h总引流量、并发症发生率及术后住院时间等效果指标。结果所有患者无需中转传统手术。线性回归分析显示手术例数与手术时间、术中出血量均呈线性关系（相关系数分别为-0.408和-0.234,P值分别为〈0.001和0.016）。3组手术时间分别为（125.0±33.5）min、（111.8±26.3）min和（100.1±25.7）min（P=0.002）,术中出血量分别为（95.7±166.0）ml、（64.3±100.8）ml和（38.3±34.3）m（lP=0.007）。两两比较,A组与C组手术时间和术中出血量差异有显著性（P值分别为0.001和0.002）。3组术后48小时总引流量、并发症发生率及术后住院时间差异无统计学意义。结论腹腔镜脾切除术治疗免疫性血小板减少性紫癜是安全可行的。随着手术例数增加,手术时间和术中出血量逐渐减少。学习曲线约为35例,可达到较熟练程度。     

Predictive factors for successful laparoscopic splenectomy in immune thrombocytopenic purpura

Background Laparoscopic splenectomy (LS) offers better short-term results than open surgery for the treatment of immune thrombocytopenic purpura (ITP), but long-term follow-up is required to ensure its efficacy. The remission rate after splenectomy ranges from 49 to 86% and the factors that predict a successful response to surgical management have not been clearly defined. The goal of this study was to determine the preoperative factors that predict a successful outcome following LS. Methods From February 1993 to December 2003, LS was consecutively performed in a series of 119 nonselected patients diagnosed with ITP (34 men and 85 women; mean age, 41 years), and clinical results were prospectively recorded. Postoperative follow-up was based on clinical records, follow-up data provided by the referring hematologist, and a phone interview with the patient and/or relative. Univariate and multivariate analyses were performed for clinical preoperative variables to identify predictive factors of success following LS. Results Over a mean period of 33 months, 103 patients (84%) were available for follow-up with a remission rate of 89% (92 patients, 77 with complete remission with platelet count >150,000). Eleven patients did not respond to surgery (platelet count <50,000). Mortality during follow-up was 2.5% (two cases not related to hematological pathology and one case without response to splenectomy). Preoperative clinical variables evaluated to identify predictive factors of response to surgery were sex, age, treatment (corticoids alone or associated with Ig or chemotherapy), other immune pathology, duration of disease, and preoperative platelet count. In a subgroup of 52 patients, we also evaluated the type of autoantibodies and corticoid doses required to maintain a platelet count >50,000. Multivariate analysis showed that none of the variables evaluated could be considered as predictive factors of response to LS due to the high standard error. Conclusion Long-term clinical results show that LS is a safe and effective therapy for ITP. However, a higher number of nonresponders is needed to determine which variables predict response to LS for ITP.     

Laparoscopic splenectomy for treatment of patients with idiopathic thrombocytopenic purpura

BACKGROUND: Laparoscopic splenectomy (LS) is one of the advanced laparoscopic procedures that benefit most from minimally invasive surgery. This study was undertaken to compare the operating time, blood loss, length of hospital stay, and platelet count response for patients with idiopathic thrombocytopenic purpura (ITP) undergoing open splenectomy (OS) versus LS. METHODS: We performed OS in 20 cases before 1992 and LS in 14 cases after 1993 for the treatment of ITP. RESULTS: The operating time was significantly shorter for OS than for LS (126 +/- 52 min versus 203 +/- 83 min, p < 0.01). Blood loss was less for OS than for LS (321 +/- 264 ml versus 524 +/- 648 ml, p = 0.287). None of the patients who underwent LS were converted to open surgery. Accessory spleens were found in four OS patients (20.0%) and four LS patients (28.6%). The postoperative hospital stay was significantly longer for OS patients than for LS patients (15.2 +/- 5.8 days versus 8.9 +/- 2.9 days, p < 0.0005). No significant difference was noted in the long-term results of splenectomy. CONCLUSIONS: Compared with OS, LS required more operating time, had the potential to cause greater blood loss, had a comparable incidence of accessory spleen and response rate, and appeared to shorten the postoperative stay.     

腹腔镜技术在脾脏切除术中的应用

目的 探讨腹腔镜脾切除术（LS）在治疗与脾脏有关疾病中的应用、手术方法及临床效果。方法 利用腹腔镜技术在CO2气腹情况下对43例需行脾切除术的患者进行手术,并对手术前后患者一般状况的改善、血小板计数的变化、并发症的出现与否及术后恢复情况等进行总结性分析。结果 43例患者全部采用LS方法完成手术,术后无并发症出现;对特发性血小板减少性紫癜（ITP）患者的有效率为89．3％;体外B超脾脏长径＞15cm者手术难度明显增加,手术时间延长。结论 只要掌握好脾切除术的手术指征及腹腔镜下的操作技巧,LS是脾脏手术的最佳方法之一。     

Laparoscopic versus open pediatric splenectomy for massive splenomegaly

Laparoscopic splenectomy (LS) has rapidly evolved into the technique of choice compared with open splenectomy (OS) because of the advantages of the minimally invasive approach. Splenomegaly increases the technical difficulties of LS. LS for massive splenomegaly has generally been found to fail in adults and children. With improvements in laparoscopic technique and accumulation of laparoscopic experience, however, concerns about completing the procedure in pediatric cases with even massive splenomegaly have been lowered. A retrospective review (April 1997-October 2009) of databases at 2 institutions identified 145 children undergoing splenectomy, 79 laparoscopic and 66 open. We defined splenic margin below the umbilicus or anteriorly extending over the midline as massive splenomegaly. By this definition, 22 cases of pediatric laparoscopic and 17 cases of open splenectomies for massive splenomegaly were performed. Perioperative and follow-up data of laparoscopic pediatric splenectomies were compared with those of open splenectomies, including operative time, bleeding, spleen size, complications, and hospital stay. There were no deaths, wound infections, or instances of pancreatitis. No accessory spleen was missed by laparoscopic; accessory spleens were missed in 2 patients in open splenectomies. The complication rate of laparoscopic versus open was 13.6% versus 41.2%. No subsequent surgery was necessary for dealing with complications both in laparoscopic and open series. Laparoscopic pediatric splenectomy for massive splenomegaly is a feasible, effective, and safe procedure and is associated with low morbidity and a short hospital stay.