Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count

Abstract

Laparoscopic splenectomy (LS) is now performed routinely in patients with idiopathic thrombocytopenic purpura (ITP) refractory to the medical treatment. Low preoperative platelet count was deemed to be a contraindication for a laparoscopic approach; however, there is no data reporting the outcome in those patients. We aimed to evaluate the influence of the preoperative platelet count on the operative and postoperative course and complication rate. Retrospective cohort study that was conducted in tertiary care university-affiliated medical center and included 110 consecutive patients who underwent LS. All patients were divided into three groups by their preoperative platelet counts: £20 · 10 9 /L (n = 12), (20-50) · 10 9 /L (n = 18), and >50 · 10 9 /L (n = 80). The outcome and the influence of preoperative factors predictive of complications, blood transfusion, and length of stay were compared between the groups. Patients with a platelet count of £20 · 10 9 /L had a much longer hospital stay, received more blood transfusions, and suffered more complications than patients with platelet counts of (20-50) · 10 9 /L or higher (P < 0.05). Transfused patients had a longer hospital stay than non-transfused patients (2.08 vs. 6.4 days, P = 0.029). The strongest predictor for transfusion was the platelet count (odds ratio = 23, P = 0.008). LS in patients with very low platelet counts is feasible and reasonably safe, but the platelet count is a major determinant of morbidity. Every effort should be made to elevate platelet levels to >20 · 10 9 /L before surgery. Patients with counts >20 · 10 9 /L can safely undergo LS. Am. J. Hematol. 80:95-100, 2005. ª 2005 Wiley-Liss, Inc.

Laparoscopic splenectomy for hematologic diseases: a preliminary analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS)

“…In this first study analyzing IRLSS data, a cohort of patients with hematologic diseases was retrospectively investigated for potentially predictive parameters that could affect LS outcome. Although blood parameters such as preoperative hemoglobin and platelet count may play a role in postoperative morbidity [13,33], they were not entered for statistical analysis because a nonhomogeneous distribution of missing data between laparoscopic centers occurred. Notwithstanding the excellent outcome for non-HM according to elective LS reporting [6,12,22,25], the role of the laparoscopic approach in HM is more complex.…”

How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment

“…38,42 As with open splenectomy, it is important to elevate platelet counts preoperatively to Ͼ 20 000/L to avoid longer hospital stay, blood transfusions, and other complications. 43 Splenectomy has a well-characterized safety profile and generally preventable complications. Perioperative complications of splenectomy include bleeding, infection, and thrombosis.…”

“…Surgical expertise combined with proper patient selection and preparation is key to reducing complication rates and involves: excluding patients with serious comorbidities for general surgery and "older" patients (age cut-offs for those in otherwise excellent health is debated), optimizing platelet counts perioperatively, and judicious use of antibiotics and thromboprophylaxis. 43 We recommend pneumococcal, meningococcal, and Haemophilus influenzae vaccination before splenectomy and periodically every 5 years or according to titers. 1,44 Splenectomy reduces cost.…”

The implications for patients undergoing splenectomy: postsurgery risk management

“…35 Good practice would be to deflate the pneumoperitoneum, wait a few minutes, and inflate a second time in order to control the hemostasis, avoiding the risk of a false absence of bleeding due to the increased pressure of the abdomen. 36 Moreover, Keidar et al 37 suggest that preoperative hemoglobin and platelet count may also play a role in postoperative morbidity and that even if this has no statistical significance, severe anemia and a very high or very low platelet count will surely influence the physical response to surgery, as well as what happens in a patient who is subject to prolonged corticosteroid therapy. In fact, in Casaccia et al's 24 study, in the group of patients affected by idiopathic thrombocytopenic purpura, some pulmonary, urinary, and skin incision infections and some hemoperitoneum or abdominal fluid collection can be explained by long-term administration of steroids and a low platelet count.…”