LAPAROSCOPIC SPLENECTOMY FOR THE PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA

A total of 28 cases of idiopathic thrombocytopenic purpura (ITP) have been treated by splenectomy in the institute. We employed open splenectomy (OS) for 19 cases before 1992 and laparoscopic splenectomy (LS) for nine cases after 1993. In this study these two procedures were compared for various parameters. Surgical time was significantly shorter for OS than that for LS (126±52 vs 244±63 min., p=0.000141). Blood loss was less for OS than that for LS (322±264 vs 713±729ml). None of patients undergoing LS were converted to open surgery. Accessory spleen was found in four patients undergoing OS (21%) and in three patients undergoing LS (33%). Postoperative hospital stay was significantly longer for patients in the OS group than the othors (39.5±28.1 vs 10.0±3.0 days, p=0.00023). No significant difference was noted in the late efficacy rates of splenectomy, namely, efficacy rates for OS versus LS were “excellent”: 53.3% vs 44.4%; “effective”: 13.3% vs 33.3%; “slightly effective”: 20.0% vs 22.2%; and “ineffective”: 13.3% vs 0%, respectively. Compared with OS, LS required more surgical time, caused greater blood loss, had a comparable response rate and incidence of accessory spleen, and appeared to shorten the postoperative stay, decrease incisional discomfort, and provide better cosmetic results, especially in younger patients. Laparoscopic splenectomy is the preferable procedure for ITP.