Laparoscopic Splenectomy for Chronic Idiopathic Thrombocytopenic Purpura

ABSTRACT

PURPOSE: In chronic idiopathic thrombocytopenic purpura (ITP), primary treatment is steroid therapy. However treatment with steroids effects a complete response in less than 30% of the patients whereas a splenectomy is successful in more than 60% of the patients who undergo it. The minimal access afforded by a laparoscopic splenectomy (LS) is considered highly desirable for these patients. The purpose of this study was to compare the clinical benefits of a LS with those of conventional open surgery (OS) for patients with ITP. METHODS: The results of 12 subsequent laparoscopic splenectomies performed from December 1996 to May 1998 were compared with those of 10 open splenectomies performed from September 1987 to May 1995. The indications of a splenectomy were medical intractability, recurrent ITP and/or complications of steroids. The operative time, the time to resumption of oral intake, the postoperative hospital stay, the platelet count, the postoperative response rate, the incidence of accessory spleen, and the period of complication after preoperative steroid administration were statistically analyzed (t-test, chi-square test). Also, the timing of the splenectomy was compared. RESULTS: The operative time was longer in the LS patients (LS 221 min, OS 127 min, p=0.0033), but the length of stay (LS 9.3+/-3.87 days, OS 4.6+/-1.92 days, p=0.0033) and duration of ileus (LS 2.9+/-0.32 days, OS 1.9+/-0.90 days, p=0.0002) were shorter in the LS group. There were no significant differences in platelet count, postopertative response rate, and incidence of accessory spleen between the two groups. Accessory spleens were found in 4 patients (18%). The conversion rate was 17% (only 2 initial cases). The splenectomy had been chosen as a second-line treatment in 91.7% and 60% of the LS and OS patients, respectively, and as a third-line treatment in 8.3% and 40% of those patients, but these result have no statistical significance. The time interval between diagnosis and operation also was not significantly different, between the two groups. CONCLUSION: A LS is safe and effective for the management of ITP and allowsrapid recovery. A LS should be the early treatment of choice for patients, who do not response to primary steroid therapy or who have recurrent or complicated ITP. When such patients are managed early surgical laparoscopic treatment, the side effects of steroid may be minimized.