Background: Laparoscopic splenectomy (LS) is a second-line therapy for Immune Thrombocytopenia (ITP). The reported sustained success rate of LS for ITP is 66%. There is concern that LS may be unsafe or ineffective in older patients. The purpose of this study is to identify factors predictive of LS success that will enable preoperative prognostication. 

Methods:  A retrospective cohort study was conducted of patients undergoing LS for ITP. Data evaluating response to medical and surgical therapy was collected. Response to therapy and disease remission were defined as a platelet level of 50x109/L with no bleeding events. Univariate and multivariate analyses evaluating factors predictive of LS success were conducted.

Results: 141 patients were reviewed. The operation was completed successfully in 96.4% of cases with a 3.6% conversion rate and 8.5% complication rate. Disease remission was achieved in 78.7% of patients. An increased number of pre-operative medical interventions decreased the odds of LS success. Age did not confer an increased risk of failure or complications. Response to initial corticosteroid therapy was associated with an LS success rate of 90% and increased odds of surgical success by 5.58 over individuals with no response to corticosteroids.

Conclusions:  LS is safe in patients ≥65 years. A greater number of pre-operative medical interventions predicts a decreased LS success rate.  Initial response to corticosteroids is associated with LS success rate of 90% and improved odds of surgical success.  LS should be the standard second line therapy for ITP, especially in patients responding to corticosteroids.

Preoperative Response to Steroids Predicts Success of Laparoscopic Splenectomy in Treating Immune Thrombocytopenia