Laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP) |
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Authors: | DE Pace PM Chiasson CM Schlachta J Mamazza EC Poulin |
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Institution: | (1) The Centre for Minimally Invasive Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8, CA |
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Abstract: | 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. |
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