• Terive Duperier, Fred Brody, Joshua Felsher, R Matthew Walsh, Michael Rosen, and Jeffrey Ponsky.
• Minimally Invasive Surgery Center and Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
• Arch Surg Chicago. 2004 Jan 1; 139 (1): 61-6; discussion 66.

HypothesisYounger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS).DesignCase series.SettingPrivate, tertiary care referral center.PatientsSixty-seven consecutive patients undergoing LS for ITP between 1995 and 2001.InterventionsLaparoscopic splenectomy.Main Outcome MeasuresA successful response to LS was defined as a postoperative platelet count greater than 100 x 10(3)/microL without medical therapy. Failures were classified as recurrent or refractory. Patients considered refractory to surgery did not achieve a platelet count greater than 100 x 10(3)/microL without medical therapy. Patients with recurrent ITP initially achieved a platelet count greater than 100 x 10(3)/microL, but thrombocytopenia subsequently recurred.ResultsBoth univariate and multivariate analyses were performed for 13 preoperative variables to identify factors predictive of success following LS. At a mean follow up of 22 months, 43 patients (64%) had a successful response to LS, 14 (21%) were refractory, and 10 (15%) developed recurrent ITP. By univariate analysis, patients responding to laparoscopic splenectomy were younger (P =.005) and had a higher preoperative platelet count (P =.005). In multivariate analysis, younger age (P =.005) and a higher preoperative platelet count (P =.007) again predicted a successful response to LS.ConclusionsA successful response to LS for ITP is expected in patients younger than 50 years and in those with preoperative platelet counts greater than 70 x 10(3)/microL. These factors can be incorporated into an equation that yields a splenectomy prediction score, which predicts the success of LS for ITP.

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