Laparoscopic management of accessory spleens in immune thrombocytopenic purpura |
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Authors: | K T Morris K D Horvath B A Jobe L L Swanstrom |
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Institution: | (1) Department of Surgery, Oregon Health Sciences University, and Department of Minimally Invasive Surgery, Legacy Health System, 501 North Graham, Suite 210, Portland, OR 97227, USA, US |
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Abstract: | Background: A disparity exists between the incidence of accessory spleens reported in the open (15–30%) versus the laparoscopic (0–12%)
literature. This disparity implies that a percentage of laparoscopic patients will require a reoperation for accessory splenectomy.
We present our experience with the laparoscopic management of accessory spleens discovered after primary splenectomy for idiopathic
thrombocytopenic purpura (ITP).
Methods: Seventeen patients who underwent primary splenectomy for ITP were reviewed (1 open, 16 laparoscopic). In the laparoscopic
group, the incidence of accessory spleens was 3 in 16 (19%). In 1 of these 3 patients, the accessory spleen was found and
removed at the initial operation, whereas in 2 of the 16 patients (13%), the accessory spleens were missed. A third patient,
whose initial operation was open, presented with recurrent thrombocytopenia after primary splenectomy. After recurrent thrombocytopenia
developed, radio nuclide spleen scans were performed showing accessory spleens in all three patients. These three patients
underwent accessory splenectomy using a four-port laparoscopic approach.
Results: Laparoscopic accessory splenectomy was successfully performed in all three patients. Location of accessory spleens correlated
with the spleen scan in each case. Mean operation time was 180 min. There were no conversions to open surgery and no complications.
All patients were discharged from the hospital on postoperation day 1. The three patients had a good clinical response and
were weaned effectively from their steroid medications.
Conclusions: Patients undergoing a laparoscopic splenectomy for chronic ITP have a higher probability of requiring a reoperation for a
missed accessory spleen. To minimize missing an accessory spleen, a systematic search should be made at the beginning of the
laparoscopic operation. We have found that preoperation imaging with heat-treated erythrocyte scans is valuable for locating
accessory spleens before reoperation. When reoperation for accessory splenectomy is necessary, a laparoscopic approach is
safe and effective.
Received: 22 July 1998/Accepted: 13 October 1998 |
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Keywords: | : Accessory spleens — Accessory splenectomy — Idiopathic thrombocytopenic purpura — ITP — Laparoscopic surgery — Splenectomy |
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