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Laparoscopic cholecystectomy in adults with sickle cell disease
G Bonatsos1, K Birbas, K Toutouzas
1First Department of Propaedeutic Surgery, Athens University, Hippokration Hospital, 114 Vas. Sofias Avenue, Athens, Greece.
Insights
Laparoscopic cholecystectomy is safe for adults with sickle cell disease (SCD) and gallstones. Early surgical intervention for uncomplicated gallbladder disease in well-prepared SCD patients is recommended.
Area of Science:
- Gastroenterology
- Hematology
- Surgical Oncology
Background:
- Adults with sickle cell disease (SCD) are prone to bilirubinate cholelithiasis due to chronic hemolysis.
- Gallstone formation is a common complication in SCD patients.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis in adults with SCD.
- To assess the impact of preoperative management on surgical outcomes in this high-risk population.
Main Methods:
- Retrospective review of 13 consecutive adult SCD patients undergoing elective LC from 1991 to 1999.
- Preoperative management included transfusion regimens (hemoglobin >/=10 g/dl) for 9 patients.
- Diagnostic procedures like ERCP and intraoperative cholangiography were used to assess for choledocholithiasis.
Main Results:
- One patient experienced transient pyrexia; no vaso-occlusive crises or deaths occurred.
- The mean hospital stay was short, averaging 3.3 days.
- Successful management of symptomatic cholelithiasis and common bile duct stones was achieved.
Conclusions:
- Laparoscopic cholecystectomy is a safe and effective treatment for symptomatic cholelithiasis in adults with SCD.
- Improved hematologist willingness to refer early, well-prepared SCD patients for elective LC.
- Early surgical intervention can prevent complications associated with gallstones in SCD.
Background:
Chronic hemolysis predisposes adults with sickle cell disease (SCD) to the formation of bilirubinate cholelithiasis.
Methods:
To study the impact of laparoscopic cholecystectomy (LC) on this groups, we reviewed our records of all patients with SCD and cholelithiasis treated electively from 1991 to 1999. During that period, 13 consecutive patients with SCD underwent elective LC for symptomatic cholelithiasis. Nine patients (69.2%) were managed with a preoperative transfusion regimen to achieve a hemoglobin value of >/=10 g/dl, independent of hemoglobin S percentage. Five patients who presented with jaundice were referred for preoperative endoscopic retrograde cholangiopancreatography (ERCP), which identified choledocholithiasis in two of them. Three other patients underwent intraoperative cholangiography, which revealed common bile duct stones in one patient.
Results:
One patient developed pyrexia for 2 days. There were no vaso-occlusive crises or deaths. The mean hospital stay was 3.3 days.
Conclusions:
LC has proven to be a safe and efficacious method for the treatment of symptomatic cholelithiasis in this high-risk population. Hematologists are now more willing to refer early, well-prepared patients with SCD and uncomplicated gallbladder disease for elective LC.