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ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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2/2018
vol. 13
 
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abstract:
Original paper

Laparoscopic splenectomy for immune thrombocytopenia in patients with a very low platelet count

Anna Zychowicz
,
Dorota Radkowiak
,
Anna Lasek
,
Piotr Małczak
,
Jan Witowski
,
Piotr Major
,
Marcin Strzałka
,
Jan Kulawik
,
Andrzej Budzyński
,
Michał Pędziwiatr

Videosurgery Miniinv 2018; 13 (2): 157–163
DOI: https://doi.org/10.5114/wiitm.2018.75847
Online publish date: 2018/05/16
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Introduction
Laparoscopic splenectomy (LS) is the gold standard in treating immune thrombocytopenia (ITP). However, there are still some problems in decision-making when considering LS in patients with a very low platelet count (PLT).

Aim
To evaluate safety outcomes of LS in patients with severe ITP and very low PLT in comparison to those with higher PLT.

Material and methods
We retrospectively analyzed consecutive patients who underwent LS in a single institution between April 1998 and December 2017. Perioperative care was based on an algorithm developed at our department which takes into consideration the patient’s PLT level. Patients were divided into 2 groups depending on the PLT level (cut-off point 50,000/mm3).

Results
The mean operative time in the low PLT group and high PLT group was 90 ±42.1 min and 95 ±45 min, respectively (p = 0.59). Intraoperative blood loss was 144 ±226.1 ml in the low PLT group and 83 ±161.24 ml in the high PLT group (p = 0.23). Complications occurred in 5 (9.09%) patients in the low PLT group and 16 (11.51%) in the high PLT group (p = 0.67). There were no conversions in the group with lower PLT, while 2 patients in the group with higher PLT had to be converted to open surgery (p = 0.38). Patients with low PLT preoperatively more often required perioperative platelet transfusions (13 vs. 1, p < 0.001).

Conclusions
Laparoscopic splenectomy is safe and feasible treatment in patients with ITP regardless of the PLT level. Still, patients with critical ITP and marginally low PLT require special awareness.

keywords:

laparoscopy, splenectomy, immune thrombocytopenia
  
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