Laparoscopic splenectomy (LS) for immune thrombocytopenic purpura has a success rate of 70–90%. This invasive procedure is sometimes required for patients with refractory thombocytopenia. However, no data on their outcome are available. If the hematologic response is inadequate, its value vis-à-vis the risk associated with major surgery is open to question. Twelve of 110 patients who underwent LS in our institution had a platelet count lower than 20 × 109/l (mean 6.6 × 109/l). Nine patients (75%) had a good-to-excellent hematologic response. The complication rate was 33%. LS in patients with very low platelet counts is feasible and yields a response rate similar to the average of patients with immune thrombocytopenic purpura. However, it bears a higher perioperative morbidity compared with LS in patients with higher counts.

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