Surgical Endoscopy

, Volume 10, Issue 10, pp 991–995

Laparoscopic splenectomy for ITP

The gold standard
  • R. L. Friedman
  • M. J. Fallas
  • B. J. Carroll
  • J. R. Hiatt
  • E. H. Phillips
Article

DOI: 10.1007/s004649900221

Cite this article as:
Friedman, R., Fallas, M., Carroll, B. et al. Surg Endosc (1996) 10: 991. doi:10.1007/s004649900221

Abstract

Background: A comparison of safety, efficacy, and cost of laparoscopic splenectomy (LS) vs open splenectomy (OS) for idiopathic thrombocytopenic purpura (ITP) was performed.

Methods: The records of 49 consecutive patients who underwent splenectomy for ITP (31 LS and 18 OS) at a large metropolitan teaching hospital between 3/91 and 8/95 were reviewed. Morbidity, mortality, hospital stay, operative time, blood loss, time to oral fluid intake, direct costs, and operating room (OR) costs were analyzed.

Results: Age, sex, comorbidity, and spleen size were similar in both groups. LS was successful in 94% of patients in whom it was attempted. Operative times showed a learning curve for LS, with average times for the last ten cases (94 ± 35 min) significantly shorter than for the first ten (p= 0.01) and also shorter than for OS (103 ± 45 min). Postsurgical hospital stay was 2.9 ± 1.3 days for LS and 6.9 ± 3.0 days for OS (p < 0.001). Patients tolerated an oral diet 1.2 ± 0.5 days after LS and 3.2 + 0.7 days after OS (p < 0.001). Direct hospital cost was $5,509 ± 3,636 for LS and $9,031 ± 12,752 for OS. In the LS group, six patients (21%) had accessory spleens identified and removed, compared with two patients (11%) in the OS group. Platelet counts did not respond in two (7%) patients in the LS group, but no accessory spleens were identified by nuclear scan. One major complication occurred in the LS group. There were no cases of splenosis or mortality in either group.

Conclusions: LS is a safe and effective treatment for ITP, with significantly shorter postoperative hospital stay than OS.

Key words: Spleen — Splenectomy — Laparoscopy — ITP — Idiopathic thrombocytopenic purpura — Thrombocytopenia 

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Copyright information

© Springer-Verlag New York Inc. 1996

Authors and Affiliations

  • R. L. Friedman
    • 1
  • M. J. Fallas
    • 1
  • B. J. Carroll
    • 1
  • J. R. Hiatt
    • 1
  • E. H. Phillips
    • 1
  1. 1.Division of General Surgery, Department of Surgery, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USAUS

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