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01.10.2016 | original article | Ausgabe 5/2016

European Surgery 5/2016

Laparoscopic splenectomy for second-line treatment of immune thrombocytopenia – analysis of 53 patients and current perspectives

Laparoscopic splenectomy for immune thrombocytopenia

Zeitschrift:
European Surgery > Ausgabe 5/2016
Autoren:
MD André Costa-Pinho, MD Diana Fernandes, MD Renato Bessa-Melo, MD Marisa Aral, MD Luís Graça, MD José Costa-Maia

Summary

Background

Splenectomy is a well-established second-line treatment for immune thrombocytopenia but novel medical therapies have changed the management of this disease. The objective of this study is to analyze the current results of splenectomy as a second-line treatment.

Methods

Retrospective analysis of 53 consecutive patients with chronic immune thrombocytopenia submitted to splenectomy from January 2007 through December 2014. Several parameters were analyzed including postoperative morbidity and outcomes after surgery.

Results

Fifty-two (98%) patients underwent successful laparoscopic splenectomy without conversion to open procedure, with a mean operative time of 103.6 ± 38.1 minutes. The median postoperative length of stay was 3 days (range 1–36 days). There were 3 (5.7%) major postoperative complications resulting in 2 (3.8%) reoperations. No splenectomy-related mortalities occurred. Fifty (94.3%) patients presented a response 1 month after surgery (45 complete responses and 5 responses). In the follow-up (mean 24.8 ± 16.9 months) 37 (75.5%) patients had a complete and sustained response after laparoscopic splenectomy and an additional 11 (22.4%) presented platelet counts above 30×109/L (the majority of these patients eventually reaching normal platelet counts). No additional therapies were needed in 39 (79.6%) patients after surgery.

Conclusions

In our experience, laparoscopic splenectomy is an effective second-line treatment for Immune Thrombocytopenia with short and long-term response rates of 94% and 91%, respectively. Major postoperative complications occurred in 6%. Future research should aim to discover new methods to properly select patients to different second-line treatments.

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