Laparoscopic Splenectomy for the Patients with Idiopathic Thrombocytopenic purpura

Takumi Shimomatsuya, Nobuhiko Tanigawa, Tetsuo Taniguchi, Hideki Noguchi, Narisato Kimura, Yoshinori Hiramatsu, Hidenori Fujii, Tetsuya Horiuchi, Yasuhiko Masuda, Ryusuke Muraoka

Second Department of Surgery, Fukui Medical University

We report two patients with idiopathic thrombocytopenic purpura (ITP) who underwent laparoscopic splenectomy. The platelet count rose following the administration of an immunosuppressant agent or a high dose of gammaglobulin, and autologous blood was donated preoperatively. In the right oblique lateral position under general anesthesia, a total of 5 trochars were inserted. First the peritoneal reflexion on the left side of the spleen was incised. Next the splenocolic ligament was separated close to the spleen. The spleen was resected by serial dissection of the gastrosplenic ligament and pancreatosplenic ligament close to the spleen with Endo-clip, Endoscissors, and Endo-GIA. The spleen was packed in an Endo-pouch, crushed, and removed from the abdomen. The splenic bed was inspected for adequate hemostasis. The estimated blood loss was from 190 ml to 200 ml and mean operation time was 3 hours and 20 minutes. The postoperative course was uneventful in both cases. The advantages of this technique are rapid recovery, minimal incisional discomfort, brief hospitalization, and superior cosmetic results, especially in younger females. In cases of ITP, steroid therapy is considered first and splenectomy or immunosuppressant agents are favored in patients who do not respond to steroid therapy. However, steroid therapy has many side effects, such as peptic ulcers, infection, diabetes mellitus, and osteoporosis. Laparoscopic splenectomy may be the preferred treatment for ITP in the near future.

Key words
laparoscopic splenectomy, idiopathic thrombocytopenic purpura

Reprint requests
Takumi Shimomatsuya Second Department of Surgery, Fukui Medical University
23-3 Shimoaiduki, Matsuoka-chou, Yoshida-gun, Fukui, 910-11 JAPAN

Accepted
February 9, 1994

To read the PDF file you will need Abobe Reader installed on your computer.