Abstract
ABSTRACT
From December 1994 to May 1997, 12 patients with idiopathic thrombocytopenia purpura (ITP) refractory to medical management underwent laparoscopic splenectomy. The primary indication for surgery was persistence of a platelet count less than 50,000 despite treatment with steroids or gamma globulin. Ages ranged from 6 to 22 years and weight from 18 to 110 kg. A four-port technique was used to perform the procedure, and laparosonic coagulating shears (Ethicon Endosurgery, Inc., Cincinnati, OH) was the primary instrument used to perform the procedure. All 12 procedures were completed successfully laparoscopically. Operative time averaged 68 minutes (range 35–110 minutes). No patient required blood or platelet transfusion, and blood loss was less than 20 cc in each case. Eleven patients were discharged on the first postoperative day and one on day 2. There were no intraoperative or postoperative complications. This series shows that laparoscopic splenectomy in patients with refractory ITP is safe, fast, and effective. The decreased postoperative morbidity makes it a superior technique to the standard open laparotomy.
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