Results of Laparoscopic Splenectomy for Immune Thrombocytopenic Purpura
Virachai Mahatharadol MD*, Somchai Meesiri MD*
Affiliation : * Department of Surgery, Rajavithi Hospital
Objective : To study the safety and efficacy of Laparoscopic Splenectomy (LS) for Immune Thrombocytopenic
Purpura (ITP).
Materials and Methods : Twenty-five consecutive adult patients with chronic ITP who did not achieve sustained
remission or refractory to medical treatment underwent elective LS between March 1995 and July 2005. The
perioperative course was documented and the follow up data were recorded.
Results : All 25 patients underwent successful LS by a single surgeon. Twenty patients were available to
analyze with a median follow-up time of 739 days (range, 18-3,555). The mean age was 29.8 years (range,
15-44) and 17 patients were female. The median preoperative platetlet count was 16,500/(cid:31)L (range, 2,000-
180,000). Accessory Spleens (AS) were removed in three patients (15%). A female patient died 24 days after
LS from fungal brain abscesses. Fifteen patients (75%) had platelet count >100,000/(cid:31)L at initial response.
Thirteen patients (65%) are in Complete Remission (CR) (platelet count >100,000/(cid:31)L). The probability of
staying in CR after LS was 60.2% by Kaplan-Meier analysis. All failures occurred within 218 days of the
operation. The mean age of the patients with CR was 27.2 years (range, 15-43) while the mean age of the
nonCR was 34.7 years (range, 21-44).
Conclusion : LS should be considered as a safe and effective therapy when elective splenectomy is indicated
for chronic ITP patients.
Keywords : Immune thrombocytopenic purpura, Laparoscopic splenectomy, Accessory spleen, Complete remission
