Laparoscopic splenectomy for ITP

Friedman, Richard L.; Fallas, M. J.; Carroll, B. J.; Hiatt, Jonathan R.; Phillips, Edward H

doi:10.1007/s004649900221

Cited by 142 publications

(82 citation statements)

References 12 publications

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“…The mean operating time in our patients (78 min) was significantly shorter compared to the median length of the operation reported by others (170 min) [6,8,9]. This may also be related to the accumulated experience of the surgeon [10,13,17].…”

Section: Discussioncontrasting

confidence: 73%

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Laparoscopic splenectomies for idiopathic thrombocytopenic purpura: Experience of sixty cases

et al. 2000

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We performed a laparoscopic splenectomy (LS) in 60 patients (age 9-83, 45 females) with idiopathic thrombocytopenic purpura (ITP) who did not achieve sustained remission on steroid therapy. Using a modified procedure, the mean duration of LS was 78 min (range 25-240 min) and surgery was associated with only 5% major and 5% minor complications. Ten patients had a platelet count less than 50 × 10 9 /l during surgery despite the administration of immune globulin (0.4 g/kg × 3-5 days) or pulsed oral dexamethasone (40 mg/day × 4 days). Three patients were refractory to these therapies and underwent LS with a platelet count less than 5 × 10 9 /l. Bleeding complications during or after surgery were rare (5%). Accessory spleens were removed in eight patients. Convalescence was rapid and the mean hospital stay was 2.3 days (range 1-7 days). The patients were followed for a mean of 16 months (range 1-36 months), and 49 patients (84%) are in complete remission. Seven patients (12.5%) relapsed despite an initial good response in 6 of them. Two patients underwent laparoscopic removal of accessory spleens with excellent response. We conclude that LS for ITP is safe and effective and associated with low morbidity and fast recovery. Thus, LS may be considered earlier in the course of ITP.

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Section: Discussioncontrasting

confidence: 73%

“…These advantages compensate for the use of expensive laparoscopic instruments making the total cost of the procedure comparable or even cheaper than CS [9,17].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic splenectomies for idiopathic thrombocytopenic purpura: Experience of sixty cases

et al. 2000

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“…The largest spleen removed laparoscopically in this series was 346 grams. Studies [4,19] generally demonstrate that return of gastrointestinal function and length of hospital stay is less with laparoscopic splenectomy, but that laparoscopic splenectomy is more costly. Much of the increased cost is due to increased operative time.…”

Section: Discussionmentioning

confidence: 98%

A Learning Curve for Laparoscopic Splenectomy at an Academic Institution

Rege¹,

Joehl

1999

Journal of Surgical Research

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“…13 Several recent studies have compared open with laparoscopic splenectomy for ITP. [19][20][21][22][23][24][25] Together these series describe 169 patients who underwent open splenectomy. The early postoperative complication rate was estimated to be 22%.…”

Section: Discussionmentioning

confidence: 99%

Morbidity and mortality in adults with idiopathic thrombocytopenic purpura

Portielje

Westendorp

Kluin-Nelemans

et al. 2001

Blood

450

391

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To study outcomes of adults with idiopathic thrombocytopenic purpura (ITP), we performed a follow-up study in a cohort of 152 consecutive patients who were treated according to a well-defined algorithm. Longterm outcomes were determined relative to the response 2 years after diagnosis, because most (93%) patients who ultimately attained platelet counts above 30.0 ؋ 10 9 /L (30 000/L) did so within this time frame. Complete follow-up for mortality could be studied in 99% of patients and for morbidity in 95% of patients, with a mean of 10.5 years. Within 2 years after diagnosis, 4 patients died, 2 were lost to follow-up, and 12 were reclassified as having secondary immune thrombocytopenia. Of the remaining 134 patients, 114 (85%) had obtained platelet counts above 30.0 ؋ 10 9 /L while all therapies had been discontinued. These patients had a long-term mortality risk equal to the general population. Twelve of 134 patients (9%), all with severe thrombocytopenia, had refractory disease and suffered a mortality risk of 4.2 (95% confidence interval, 1.7-10.0). Bleeding and infection equally contributed to the death of these patients. Another 8 patients (6%) had platelet counts above 30.0 ؋ 10 9 /L while on maintenance therapy. Similar to patients with refractory disease, these latter patients had considerably increased ITPrelated hospital admissions, but mortality was only slightly higher than in the general population. In conclusion, most adults with ITP have a good outcome with infrequent hospital admissions and no excess mortality.

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Laparoscopic splenectomy for ITP

Abstract: LS is a safe and effective treatment for ITP, with significantly shorter postoperative hospital stay than OS.

Cited by 142 publications

References 12 publications

Laparoscopic splenectomies for idiopathic thrombocytopenic purpura: Experience of sixty cases

Laparoscopic splenectomies for idiopathic thrombocytopenic purpura: Experience of sixty cases

A Learning Curve for Laparoscopic Splenectomy at an Academic Institution

Morbidity and mortality in adults with idiopathic thrombocytopenic purpura

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