Laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP) |
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Authors: | C J Stanton |
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Institution: | (1) Department of Surgery, Sacred Heart Medical Center, 1255 Hilyard Street, Eugene, OR 97401, USA, US |
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Abstract: | 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 |
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Keywords: | : Spleen — Splenectomy — Laparoscopy — ITP — Thrombocytopenic purpura |
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