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Laparoscopic Splenectomy in Patients With Refractory or Relapsing Thrombotic Thrombocytopenic Purpura
Joseph Schwartz, MD;
Amiram Eldor, MD;
Amir Szold, MD
Arch Surg. 2001;136:1236-1238.
Hypothesis Thrombotic thrombocytopenic purpura (TTP) is a rare and serious hematological disease. First-line therapy is plasma exchange, often used in combination with corticosteroids, vincristine, aspirin, and dipyridamole. The role of splenectomy for patients resistant to or dependent on plasma therapy and for the prevention of TTP relapses is not yet determined. Laparoscopic splenectomy (LS) is effective and safe for the treatment of the chronic relapsing form of TTP.
Intervention We performed LS in 8 patients with refractory or relapsing TTP. The operative as well as the early and late postoperative course and complications were recorded.
Results The mean duration of LS was 70 minutes (range, 35-180 minutes). There were no serious bleeding complications during or after surgery. Convalescence was rapid, and the mean hospital stay was 2.5 days (range, 1-9 days). Patients were followed up for a mean of 32 months (range, 19-54 months). Seven patients are in remission with no relapse of TTP. One patient with familial TTP had multiple relapses before and after surgery.
Conclusions Laparoscopic splenectomy for refractory or relapsing TTP is safe and associated with low morbidity and fast recovery. It is effective in the long-term prevention of TTP relapses in most patients, and it should probably be considered early in the course of chronic, relapsing TTP.
From the Department of Hematology (Drs Schwartz and Eldor) and the Advanced Endoscopic Surgery Service, Tel Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine (Dr Szold), Tel Aviv University, Tel Aviv, Israel.
RELATED ARTICLE
Laparoscopic Splenectomy in Patients With Refractory or Relapsing Thrombotic Thrombocytopenic Purpura—Invited Critique
Manuel Trias and Eduardo Ma Targarona
Arch Surg. 2001;136(11):1239.
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