Esplenectomía laparoscópica o esplenectomía abierta en el tratamiento de la púrpura trombocitopénica idiopática

Abstract

Laparoscopic splenectomy (LS) is gaining acceptance as an effective and safe alternative to open splenectomy (OS) in the treatment of benign hematologic disorders unresponsive to medical treatment. Among these disorders, the most important is idiopathic thrombocytopenic purpura (ITP). We compared a cohort of 20 patients who had undergone LS in the previous 7 years, with a historical cohort of 38 patients who underwent OS between 1985 and 1999. All patients in the two groups were diagnosed with ITP unresponsive to medical treatment. The mean age of the patients was 41 years in the LS group and 39.7 in the OS group. Mean spleen size and weight were 11 cm and 150 g in the LS group and 9.9 cm and 190 g in the OS group. Preoperative platelet count was 78 x 10(9) in the LS group and 69 x 10(9) in the OS group. Accessory spleens were detected in 15% of patients in the LS group and in 16% of those in the OS group. The mean operative time was 180 minutes in LS and 85 minutes in OS (p < 0.001). The complications rate was 25% in LS and 21% in OS. The mean length of hospital stay was 3 days in the LS group and 9.4 days in the OS group (p < 0.001). No differences were observed in early and complete long-term remission. Compared with OS, LS requires a longer operative time and reduces hospital stay. Detection of accessory spleens, complication rates, and effectiveness in terms of early and long-term remission are similar in both procedures. In our opinion, LS should be considered the procedure of choice for the treatment of benign hematological disorders unresponsive to medical therapy.