Laparoscopic surgery has recently extended its indications and it has also become an acceptable surgical approach for
splenectomy. In the last five years, we have performed 40 laparoscopic
splenectomies for
immune thrombocytopenic purpura. Thirty-five patients were female and 5 patients were male. The mean age was 34, varying from 17 to 56. After learning to perform laparoscopic
splenectomy with five ports, we are now usually using three or four ports in a right lateral kidney position. There was no case of conversion to exploratory
laparotomy. The mean
hospital stay was 7 days. There was no perioperative mortality; but in 2 cases we had postoperative
subphrenic abscesses which were successfully managed by
catheter drainage. Since undergoing laparoscopic
splenectomy, 28 patients (70%) were weaned effectively from their
steroid medications. Eight patients (20%) have been on small doses of
steroid, and 4 patients (10%) have been on the same doses of
steroid with no response. The patient group with rapidly increasing platelet count after
splenectomy showed a statistically significant relation with the complete response group (p < 0.001). Laparoscopic
splenectomy is a safe and reasonable operative procedure for patients with
immune thrombocytopenic purpura.