Splenectomy

Laparoscopic splenectomy has been shown to be advantageous when compared to open splenectomy and is comparable to open splenectomy in terms of safety and efficacy in nonpregnant patients (110).

Some authors advocate laparoscopic splenectomy as the procedure of choice for hematological conditions in nonpregnant patients (111). Autoimmune throm-bocytopenic purpura is the most common autoimmune disorder encountered in the pregnant patient (112). ITP appears during pregnancy with an incidence of 1-2 cases per 10,000 pregnancies (113). No consensus has been reached as to the management of ITP during pregnancy. Maternal IgG antibodies cross the placenta leading to thrombocytopenia in the fetus and increased maternal platelet counts in response to treatment may not reliably predict fetal platelet counts. Maternal ITP may lead to intracerebral hemorrhage in the fetus or cause the fetus to experience life-threatening bleeding during the normal trauma of delivery. While immunoglobulin therapy is considered safe in pregnancy, it is expensive and steroid therapy may increase the incidence of pregnancy-induced hypertension, gestational diabetes, and infection (114).

Splenectomy has become the recommended treatment option during pregnancy for patients who are unresponsive to medical therapy (112,115). As more experience is obtained with splenectomy during pregnancy for ITP, surgery may play a larger role in the future as has happened with other procedures during pregnancy. To date, there have been four reported cases of laparoscopic splenectomy during pregnancy. The indications for surgery were refractory hematological disorders including antiphos-pholipid syndrome, hereditary spherocytosis, and autoimmune thrombocytopenia purpura (113,114,116,117). All patients did well postoperatively and delivered healthy infants.

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