Splenectomy - the good and the bad

I have been keeping my eyes open for a good summary of the odds in favor of and against splenectomy, and this is pretty complete and concise. It comes from an article,
New treatments for idiopathic thrombocytopenic purpura: rethinking old hypotheses
Donald M Arnold † , Ishac Nazi & John G Kelton
www.blood.ca/CentreApps/Internet/UW_V502_MainEngine.nsf/resources/Medical_Publications/$file/New_treatments_for_idiopathic.pdf

Of all treatments, splenectomy is associated with the
highest rate of durable platelet count responses with longterm
follow-up. In the largest systematic review of the efficacy
and safety of splenectomy for ITP, Kojouri and colleagues
reported that 66% of 2623 adults achieved a normal platelet
count and responses were durable for a median of 7.3 years [71] .
Relapses occurred in 15% of patient (range 0 – 51%) after
a median follow-up of 33 months. Laparoscopic splenectomy
is an increasingly popular surgical approach for the management
of ITP [72] . Platelet count responses and the frequency
of missed accessory spleens causing recurrent disease are
similar to open splenectomy, but complications are fewer
and length of hospital stay is shorter [73] . Overall mortality
is approximately 1% after laparotomy and 0.2% after laparoscopic
splenectomy [71] . The most frequent perioperative
complications are pleuropulmonary (pneumonia, subphrenic
abscess, pleural effusion) occurring in 4% of patients, major
bleeding in 1.5%, and thromboembolism in 1%. The major
long-term risk is overwhelming sepsis, which occurs with a
frequency of 3.2% overall, with an associated mortality rate of
1.4%, considering all indications for splenectomy [74] . Streptococcus
pneumoniae , Neisseria meningitidis and Haemophilus
influenzae type B vaccines are recommended at least 2 weeks
prior to splenectomy [75] .
Patients with chronic refractory ITP post splenectomy
have the highest risk of morbidity and mortality including
serious hemorrhage, infection and death [46] . Treatment of
refractory patients with conventional therapies is challenging
and often unsatisfactory because of the lack of effect and/or
the frequency of toxicities [76] .

Especially notable: Successful splenectomies remained successful for a median of 7.3 years, hardly a permanent cure for most!

I was wondering when that was written. 2009.

It's a good article, but I wish they would say a bit more. None of the articles answer the questions that go through my head as I'm reading them, such as: Overall mortality
is approximately 1% after laparotomy and 0.2% after laparoscopic splenectomy - When? Days following surgery or years later? Maybe both since it says 'overall'?

I would say that it means 1% and 0.2% mortality PERI-OPERATIVELY. Long term - 1.4% mortality from sepsis alone. Other infections and clotting... I haven't seen any numbers.