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Invited Critique
November 2001

Laparoscopic Splenectomy in Patients With Refractory or Relapsing Thrombotic Thrombocytopenic Purpura—Invited Critique

Arch Surg. 2001;136(11):1239. doi:10.1001/archsurg.136.11.1239

Schwartz et al demonstrate in this short series of splenectomies for the infrequent indication of TTP the advantages of the laparoscopic approach. In the hands of this experienced laparoscopic surgery team, laparoscopic splenectomy in high-risk hematological patients was followed by good immediate results (no conversion, no severe morbidity, and a 2½-day hospital stay) and a satisfactory long-term outcome. Usefulness of splenectomy for TTP is controversial,1 and definitive guidelines are difficult to prescribe because of the scarce incidence of this disease because it has been related to significant postoperative morbidity, and because the long-term result has not been homogeneous in the literature. The spleen in patients with TTP is of normal size, and this feature facilitates the LS. This example should be added to other indications for splenectomy (idiopathic thrombocytopenic purpura, acquired immunodeficiency syndrome–related idiopathic thrombocytopenic purpura malignancy, splenomegaly), in which LS has shown clear clinical advantages (low technical and medical postoperative complications) despite the fact that open splenectomy has been classically related to a significant amount of nonsevere and severe complications.2-4