A Novel Method for Laparoscopic Splenectomy in the Setting of Hypersplenism Secondary to Liver Cirrhosis: Ten Years’ Experience

Cai, Yunqiang; Liu, Xuedong; Peng, Bing

doi:10.1007/s00268-014-2652-6

Cited by 4 publications

(1 citation statement)

References 29 publications

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“…Although laparoscopic splenectomy seems safe and feasible also in patients with platelets <10 × 10 9 /l with meticulous surgical technique (Cai et al , ), other studies have suggested an increased risk of bleeding with platelets <20 × 10 9 /l (Keidar et al , ). In patients responsive to a short‐course of IVIg or other medical therapy, we suggest to increase platelet count before surgery to above 30–50 × 10 9 /l.…”

Section: Consolidated Results Of Splenectomymentioning

confidence: 99%

A critical appraisal of the evidence for the role of splenectomy in adults and children with ITP

Rodeghiero

2018

Br J Haematol

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In primary chronic immune thrombocytopenia, long-term response to splenectomy, with 60% of patients enjoying a treatment-free life, is higher when compared with rituximab and similar to that with continuous thrombopoietin-receptor agonists (TPO-RA) administration. Splenectomy should continue to be offered to patients failing initial treatments in the absence of increased surgery-related risks. The higher lifelong safety concerns with splenectomy (increased risk of infection, shared in part with rituximab, and of thrombosis, in common with TPO-RA) and a mortality <1-2%, justify postponing surgery to the chronic phase, when spontaneous remissions are rarer. Patients failing initial treatment with corticosteroids/intravenous immunoglobulin may use TPO-RA (or rituximab in selected cases) as a bridge to surgery if they prefer to reconsider splenectomy later on, in case of no response, adverse effects or if sustained response after stopping TPO-RA is not attained. Special considerations apply in children aged ≤5 years, with splenectomy playing a marginal role. The recent approval of TPO-RA in children may represent a major advancement.

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Section: Consolidated Results Of Splenectomymentioning

confidence: 99%