Accessory splenectomy for refractory immune thrombocytopenic purpura

Patients with immune thrombocytopenic purpura (ITP) will frequently relapse following splenectomy. The removal of residual spleens remains a therapeutic option in these patients though the effectiveness of this procedure remains unclear. We present a single institution study of outcomes in patients who underwent an accessory splenectomy (AS) for refractory ITP. The study cohort represents a consecutive group of splenectomized patients with ITP who underwent AS for refractory disease. Fourteen patients were identified: 10 adult and 4 pediatric patients. Response was assessed at 4 weeks using standard criteria for complete response (CR), partial response (PR), or no response (NR). Eight adult patients underwent open AS, and two underwent uneventful laparoscopic AS. Overall, 50% (5/10) of adult patients responded (CR or PR) to AS at 1 month. Fifty percent (2/4) of pediatric patients achieved response. Clinical determinants suggestive of a response to AS in adults were female gender, favorable response to prednisone at first exposure and absence of Howell-Jolly Bodies prior to AS. These data suggest that laparoscopic AS remains a viable treatment option for patients with refractory ITP following splenectomy. However, given the role for novel medical therapies for refractory ITP, the potential morbidity of this surgical procedure must be weighed against its effectiveness.