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Accessory Splenectomy: the Keystone of Success in the Treatment for Refractory Immune Thrombocytopenia

  • Salvatore MarcheseEmail author
  • Eva Intagliata
  • Rosario Vecchio
Review Article
  • 18 Downloads

Abstract

Splenectomy is officially recognized as second-line treatment for immune thrombocytopenia. Accessory spleens are known to have a role in recurrence and laparoscopic exploration for detection is recommended by many. The aim of the study was to investigate on accessory splenectomy as resolutive treatment for refractory thrombocytopenia. A review of the literature was completed on PubMed looking for articles where at least one accessory splenectomy had been performed for refractory thrombocytopenia. Measures used for the statistical analysis were as follows: sex; age; surgical approach; latency to recurrence; radiological tests; identified, retrieved, and missed accessory spleens; location and size of accessory spleens; and follow-up. Outcome was evaluated in terms of platelet count, need for medical treatment, and response. Thirty-three articles from 1976 (95 patients) satisfied criteria for the analysis. In the young, accessory spleens were more frequently missed at imaging. Number and size of accessory spleens resulted to be inversely correlated. Smaller accessory spleens carried increased likelihood to be missed. Number of radiological tests used to detect accessory spleens yielded better outcomes, in particular, when ultrasonography, computed tomography and scintigraphy were used in combination. In the case of refractory immune thrombocytopenia, the presence of accessory spleens needs to be investigated. A special focus is required to young patients or those with multiple accessory spleens, where imaging fails to detect them more frequently. The use of combined radiological techniques has shown improved outcome and should be preferred. A meticulous laparoscopic exploration follows next and becomes crucial to achieve long-term response.

Keywords

Accessory splenectomy Accessory spleens Immune thrombocytopenia Laparoscopic surgery 

Abbreviations

AcS

accessory spleens

AcSy

accessory splenectomy

CR

complete response

d

days

FU

follow-up

HD-RBC

heat-denatured red blood cells

ITP

immune thrombocytopenia

m

months

NOS

not otherwise specified

NR

no response

PLT

platelets

R

response

Rad

radiologically detected

Surg

surgically detected

TPO-RA

thrombopoietin receptor agonists

y

years

Notes

Authors’ Contributions

Study conception and design: Marchese, Vecchio

Acquisition of data: Marchese, Intagliata

Analysis and interpretation of data: Marchese, Vecchio

Drafting of manuscript: Marchese, Intagliata

Critical revision: Marchese, Vecchio

Compliance with Ethical Standards

Competing Interests

The authors declare that they have no competing interests.

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Copyright information

© Association of Surgeons of India 2019

Authors and Affiliations

  1. 1.Department of General Surgery and Medical-Surgical SpecialtiesUniversity of Catania, “Policlinico - Vittorio Emanuele” University HospitalCataniaItaly

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