Accessory splenectomy for refractory immune thrombocytopenic purpura

Updated international consensus report on the investigation and management of primary immune thrombocytopenia

“…138,148,210,211 If not already done, splenectomy can also be reconsidered, as can searching for an accessory spleen. 212 In patients failing 1 medical therapy, changing to another medical treatment may be successful. Rare patients may benefit from HSCT.…”

“…Although the study suggests that laparoscopic accessory splenectomy is a treatment option for patients with ITP that is resistant to splenectomy, the added risk of morbidity and the difficulty of finding an accessory spleen in a previous surgical field must be weighed against the likely effectiveness (50%-60%) of the procedure (evidence level IIb). 212 Combination therapy. Two studies assessed combination therapy.…”

The role of laparoscopy in the identification and management of missing accessory spleens after primary splenectomy: A case report and literature review

“…[ 8 ] Moreover, six case series have been reported that describe the efficacy of accessory splenectomy in 38 adults and 12 children for recurrent ITP and are summarized in Table 1 . [ 1 2 3 5 9 10 11 ] Based on these retrospective series, the laparoscopic splenectomy appears to be safe and effective in selected patients although this procedure has been reported to be associated with a higher probability of missing splenuculi; therefore, laparotomy is recommended instead of laparoscopy. [ 5 ]…”

“…The clinical efficacy of a supplementary accessory splenectomy (open or laparoscopic) has varied between clinical studies of adults, and there are few data regarding its safety and efficacy in children with chronic ITP. [ 1 2 3 ]…”

Accessory spleens recapitulate the immune microenvironment of the main spleen in immune thrombocytopenia

“…1,2 These immune functions justify the relevance of splenectomy as second-line therapy for ITP, with clinical response rates ranging from 50% to 70%. [3][4][5] Despite this, the recourse to splenectomy is progressively decreasing due to the risk of life-threatening complications, the long-term susceptibility to infections and the advent of alternative medical therapies. 5 To support therapeutic decisions, several studies have tried to identify clinical predictors of response to splenectomy.…”