J Korean Surg Soc.
2000 Jul;59(1):101-107.
Laparoscopic Splenectomy for Chronic Idiopathic Thrombocytopenic Purpura
- Affiliations
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- 1Department of General Surgery, Andong General Hospital.
- 2Department of General Surgery, Kyungpook National University Hospital.
- 3Department of Hemato-Oncology, Kyungpook National University Hospital.
Abstract
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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.