Splenectomy: Does it still play a role in the management of thrombotic thrombocytopenic purpura?

Article Figures & Tables

Table 3

Studies involving patients who underwent splenectomy for relapsing thrombotic thrombocytopenic purpura

Study	No. of patients	Surgical method	No. (%)			Follow-up, mean (range), mo.^*	Comment
Study	No. of patients	Surgical method	Deaths	Complications	Postsplenectomy relapses	Follow-up, mean (range), mo.^*	Comment
Liu et al.7	2	Open	0	1 (50)	0	7, 7	Complication: postoperative hemorrhage requiring a repeat laparotomy
Wells et al.8	1	Open	0	0	0	30
Eldor et al.9	2	Open	0	0	0	28, 35
Onundarson et al.4	6	Open	0	1 (17)	0	42 (11–68)	Complication: incisional hematoma
Hoffkes et al.10	2	Open	0	0	0	24, 24
Veltman et al.11	5	Open	0	0	0	39 (9–62)
Crowther et al.12	6	Open	0	0	2 (33)	45 (10–96)
Rund et al.13	2	Open	0	0	0	10, 52
de la Rubia et al.14	2	Laparoscopic	0	0	1 (50)	11, 26
Schwartz et al.15	6	Laparoscopic	0	0	0	32 (19–54)
Wichmann et al.16	2	Laparoscopic	0	0	0	11, 32
Modic et al.17	2	Laparoscopic	0	0	0	5, 13
Essien et al.18	2	Laparoscopic	0	0	0	16, 19
Aqui et al.19	8	Open	1 (12.5)	0	4 (50)	21 (1–67)	One patient died from relapsing TTP 2 days after splenectomy
Zomas et al.20	5	Open	0	0	0	13^‡
Kremer Hovinga et al.21	2	Not reported	0	0	0	44, 91
Kappers-Klunne5	24	Open^†	0	3 (12.5)	6 (25)	111 (9–230)	Complications: 1 wound infection, 1 subphrenic abscess and 1 pancreatic injury with fluid collection
Outschoorn and Ferber22	3	Not reported	0	0	2 (66)	43 (2–80)
Present study	5	Laparoscopic	0	0	0	43 (40–48)
Total	87		1 (1.2)	5 (6)	15 (17)

Table 4

Studies involving patients who underwent splenectomy for refractory thrombotic thrombocytopenic purpura

Study	No. of patients	Surgical method	No. (%)			Follow-up, mean (range), mo.^*	Comment
Study	No. of patients	Surgical method	Deaths	Complications	Failure to respond to splenectomy	Follow-up, mean (range), mo.^*	Comment
Thompson and McCarthy23	2	Open	0	1 (50)	0	4, 8	Complication: Staphylococcal infection
Evans et al.24	2	Open	0	0	0	12, 12
Schneider et al.25	6	Open	0	2 (33)	0	11 (6–14)	Complications: pneumonia and postoperative hemorrhage
Liu et al.7	5	Open	0	0	1 (20)	18 (8–36)
Wells et al.8	2	Open	0	0	0	6, 36
Hayward et al.26	13	Open	2 (15)	Not reported	0	20 (6–67)	Two deaths following splenectomy, specific cause not reported
Winslow and Nelson.27	6	Open	0	0	0	21 (6–38)
Rund et al.13	2	Open	0	0	1 (50)	21, 86
Mant et al.28	7	Open	1(14)	0	1 (14)	29 (18–37)	One patient failed to respond and died of TTP
de la Rubia et al.14	2	Laparoscopic	0	0	0	11, 26
Schwartz et al.15	2	Laparoscopic	0	1 (50)	1 (50)	^†	Complication: postoperative hematoma in splenic bed
Rosen et al.29	9	Laparoscopic	0	2 (22)	1 (11)	13 (1–30)	Complications: 1 diaphragmatic tear and 1 retroperitoneal hematoma
Aqui et al.19	6	Open	0	0	0	147 (72–176)
Kremer Hovinga et al.21	1	Not reported	0	0	0	46
Kappers-Klunne et al.5	9	Open^‡	1 (11)	1 (11)	1 (11)	92 (28–201)	One patient did not respond and died of TTP postoperatively, 1 patient developed a pulmonary embolism postoperatively
Total	74		4 (5)	7 (10)^§	6 (8)

TTP = thrombotic thrombocytopenia purpura.
↵* Or the number of months in studies with 1 or 2 patients.
↵† Follow-up included in patients with relapsing TTP from Table 3.
↵‡ Includes 1 laparoscopic case.
↵§ Excludes Hayward et al.,26 who did not report the complication rate following splenectomy.