International Journal of Scientific and Research Publications, Volume 5, Issue 3, March 2015 1 ISSN 2250-3153 www.ijsrp.org Laparoscopic splenectomy versus open splenectomy for immune thrombocytopenic purpura Dr. Ravikiran, Prof. L. Ramachandra, Dr. Rajesh Nair Dept of General Surgery, Manipal University Abstract- Background: Idiopathic thrombocytopenic purpura (ITP) is an acquired disorder in which there is immune-mediated destruction of platelets. ITP is characterized by mucocutaneous bleeding and a low, often very low platelet count with an otherwise normal peripheral blood cells and smear. Patients usually present either with ecchymoses and petechiae or with thrombocytopenia incidentally found on a routine complete blood count (CBC). Mucocutaneous bleeding, such as oral mucosal, gastrointestinal, or heavy menstrual bleeding may be present. Rarely, life threatening including central nervous system bleeding can occur. Splenectomy was initially described as a therapeutic measure for idiopathic thrombocytopenic purpura (ITP) by Kaznelson in 1916. 1 This procedure remained the only effective treatment for ITP until 1951, when Harrington and colleagues 2 discovered the role of plasma immunoglobulin in the induction of thrombocytopenia in ITP. Dameshek et al. 3 coined the term hypersplenism and demonstrated a rise in platelet counts with the administration of steroids. Since then, medical management has been the primary treatment for ITP. Today, splenectomy is indicated in (1) refractory symptomatic thrombocytopenia after 4 to 6 weeks of medical therapy, (2) when toxic doses of steroids are required to achieve remission, and (3) for relapse of thrombocytopenia after an initial response to steroid therapy. Methods • 54 patients underwent splenectomy for ITP in our hospital were included in the study. • This is a prospective and retrospective study. -Study period: Retrospective study from January 2003- March 2012. Prospective study from April 2012- July 2014. • Institutional ethical committee clearance was obtained. Findings • From our study it is observed that laparoscopic splenectomy for ITP offers following advantages over open splenectomy: 1. Lesser intraoperative blood loss. 2. Lesser intraoperative and postoperative platelet and blood transfusion. 3. Lesser pain and duration of intravenous analgesia 4. Lesser duration of nil by mouth and early resumption to general normal diet. 5. Early drain removal Interpretation Laparoscopic approach may be considered as a better choice of approach for splenectomy in patients with ITP in view of less intraoperative blood loss, less post operative pain, lesser time to resume to normal diet and better cosmetic value. Funding None I. INTRODUCTION diopathic thrombocytopenic purpura (ITP) is an acquired disorder in which there is immune-mediated destruction of platelets. ITP is characterized by mucocutaneous bleeding and a low, often very low platelet count with an otherwise normal peripheral blood cells and smear. Patients usually present either with ecchymoses and petechiae or with thrombocytopenia incidentally found on a routine complete blood count (CBC). Mucocutaneous bleeding, such as oral mucosal, gastrointestinal, or heavy menstrual bleeding may be present. Rarely, life threatening including central nervous system bleeding can occur. Splenectomy was initially described as a therapeutic measure for idiopathic thrombocytopenic purpura (ITP) by Kaznelson in 1916. 1 This procedure remained the only effective treatment for ITP until 1951, when Harrington and colleagues 2 discovered the role of plasma immunoglobulin in the induction of thrombocytopenia in ITP. Dameshek et al. 3 coined the term hypersplenism and demonstrated a rise in platelet counts with the administration of steroids. Since then, medical management has been the primary treatment for ITP. Today, splenectomy is indicated in (1) refractory symptomatic thrombocytopenia after 4 to 6 weeks of medical therapy, (2) when toxic doses of steroids are required to achieve remission, and (3) for relapse of thrombocytopenia after an initial response to steroid therapy. Until recently, splenectomy had been performed exclusively as an open surgical procedure. In 1991, Delaitre and Maignien 4-10 reported the first successful laparoscopic splenectomy (LS). Since then, multiple studies have suggested that LS is effective, feasible, safe, and provides clinical and economic benefits such as shorter hospital stay, less postoperative pain, and fewer complications over open splenectomy (OS). Because laparoscopic splenectomy is associated with less abdominal trauma, operative platelet consumption and therefore need for platelet transfusion may be reduced during laparoscopy compared with open surgery. I