Indications and results of laparoscopic splenectomy for immune thrombocytopenic purpura

ITP is an autoimmune disease secondary to autoantibodies against platelets, characterized by skin purpura and bleeding. Treatment of ITP is palliative. 1(st) treatment are steroids and 2(nd) splenectomy. Anatomical and clinical features of ITP favor LS. Patients with ITP are young and healthy and the spleen is small. Immediate outcome of LS is similar to lap cholecystectomy. However, there are several controversies in relation to LS for ITP. 1.- Lack of randomized trials comparing open and LS.. Diverse retrospective analyses have shown the advantages of the LS when compared with the open.. 2.-Other controversy is the risk of leaving splenic tissue after LS. An essential step is to search for the existence of AS and to avoid capsule and bag rupture during morcellation. 3.- Last controversy is long term efficacy of LS. Several studies show a similar long term results than after open splenectomy, Current knowledge permit to conclude that LS is an alternative to conventional surgery for ITP. Careful search of accessory spleens, and avoidance of capsule tearing are essential to avoid recurrences of the ITP.