Laparoscopic accessory splenectomy for recurrent idiopathic thrombocytopenic purpura and hemolytic anemia

Abstract

Laparoscopic accessory splenectomy is associated with a low rate of morbidity and a short hospital stay. Despite its success in removing all residual splenic tissue, most patients will probably not enjoy a complete remission.

Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients

“…Similarly to other laparoscopic procedures it is characterized by shorter hospital stay, lower perioperative complication rate, better cosmetic result and earlier return to full working activity, which are the most important advantages over the open approach [4,13,14,16]. Lack of an immediate, satisfactory result from the operative treatment, or the recurrence of the thrombocytopenia, is almost entirely connected with the remaining splenic tissue [10,11,12,17,19,20,21]. The incidence of ectopic splenic tissue is quite high and reaches from 19 to 41%, although the difficulty in visualizing it before the surgery is also significant [10,11,12,19,21].…”

Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen

“…Lack of immediate and satisfactory post-splenectomy result or recurrence of thrombocytopenia are almost entirely connected with the remaining splenic tissue (7)(8)(9)(10)(11)(12)(13). Most authors, despite the use of different imaging techniques (ultrasonography, US; classic and spiral Computed Tomography, CT; and scintigraphy) underline the lack of reliable ways of preoperative assessment of ectopic splenic tissue (9, 10, 14, 15).…”

“…Gigot et al (9) studied CT scan results, demonstrating preoperative diagnosis of AcS, verified during laparoscopic splenectomy, only in 25% of patients. Morris, Szold and Targarona concluded that the key point should be the identification and the removal of the accessory splenic tissue during the primary surgery (7,8,15).…”

“…The literature provides a wide disparity in the efficacy of repeat surgery. After splenectomy the succesful response has been reported in 26.7% to 75% (7,8,21). Although a complete response following accessory splenectomy may not be possible, most patients can realize some benefits from the intervention because of the decreased requirement for systemic immunosuppressive therapies.…”

Intrapancreatic accessory spleen: a rare cause of recurrence of immune thrombocytopenic purpura

“…In case of open splenectomy, Akwari et al 7 described nine patients undergoing open accessory splenectomy for recurrent ITP, showing complete remission in six patients. In laparoscopic approach, Szold et al 8 describe successful laparoscopic accessory splenectomy in eight patients with recurrent ITP. None experienced complete response, with two having partial remission.…”