Laparoscopic versus open splenectomy in the treatment of idiopathic thrombocytopenic purpura: an Indian experience.

Abstract Laparoscopic splenectomy (LS) is emerging as the treatment of choice over open splenectomy (OS) in cases of idiopathic (immune) thrombocytopenic purpura (ITP) that is either steroid resistant or steroid unresponsive.The aim of the present study is to compare therapeutic response and outcome of patients with ITP undergoing LS with a similar group undergoing OS.The study was performed on 63 patients with ITP attending Medical College and Hospital, Kolkata, a tertiary level referral centre in Eastern India during 2005-2009.Twenty-seven patients with ITP underwent LS and the rest underwent OS. Twenty-eight patients were steroid resistant whereas the rest were diagnosed to be refractory to steroids. Parameters assessed were demographic characteristics of patients, peri-operative data, complications and haematological outcome.The patients were followed up for a mean period of 40 months. Demographic characteristics of the patients in LS and OS group were comparable. Patients undergoing LS were found to require a longer operative time but had lower intra-operative blood loss, less postoperative pain, decreased incidence of complications, reduced hospital stay and comparable haematological response as compared to that for patients undergoing OS. LS for ITP is a safe technique associated with lower morbidity and faster convalescence and similar haematological response when compared to OS.