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Terive Duperier, MD; Fred Brody, MD; Joshua Felsher, MD; R. Matthew Walsh, MD; Michael Rosen, MD; Jeffrey Ponsky, MD

Arch Surg. 2004;139:61-66.

Hypothesis  Younger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS).

Design  Case series.

Setting  Private, tertiary care referral center.

Patients  Sixty-seven consecutive patients undergoing LS for ITP between 1995 and 2001.

Interventions  Laparoscopic splenectomy.

Main Outcome Measures  A successful response to LS was defined as a postoperative platelet count greater than 100 x 10³/µL without medical therapy. Failures were classified as recurrent or refractory. Patients considered refractory to surgery did not achieve a platelet count greater than 100 x 10³/µL without medical therapy. Patients with recurrent ITP initially achieved a platelet count greater than 100 x 10³/µL, but thrombocytopenia subsequently recurred.

Results  Both univariate and multivariate analyses were performed for 13 preoperative variables to identify factors predictive of success following LS. At a mean follow up of 22 months, 43 patients (64%) had a successful response to LS, 14 (21%) were refractory, and 10 (15%) developed recurrent ITP. By univariate analysis, patients responding to laparoscopic splenectomy were younger (P = .005) and had a higher preoperative platelet count (P = .005). In multivariate analysis, younger age (P = .005) and a higher preoperative platelet count (P = .007) again predicted a successful response to LS.

Conclusions  A successful response to LS for ITP is expected in patients younger than 50 years and in those with preoperative platelet counts greater than 70 x 10³/µL. These factors can be incorporated into an equation that yields a splenectomy prediction score, which predicts the success of LS for ITP.

From the Minimally Invasive Surgery Center and Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio (Drs Duperier, Walsh, Rosen, and Ponsky); and the Department of General Surgery, George Washington University, Washington, DC (Drs Brody and Felsher).

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