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Mini-laparoscopic cholecystectomy in children under 10 years of age with sickle cell disease
Mohamed I Seleem1, Ahmed M Al-Hashemy, Sahar S Meshref
1Department of Surgery, Armed Forces Hospitals, Southern Region, Khamis Mushayt, Saudi Arabia. saleem_1961@hotmail.com
Insights
Mini-laparoscopic cholecystectomy (MLC) is a safe and effective treatment for gallstones in children with sickle cell disease (SCD). This procedure significantly reduces recurrent abdominal pain, improving the quality of life for young patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hematology
Background:
- Cholelithiasis (gallstones) is a common complication in patients with sickle cell disease (SCD).
- Recurrent abdominal pain is a frequent symptom, impacting quality of life.
- Optimal management, particularly in pediatric SCD patients, remains a subject of debate.
Purpose of the Study:
- To assess the safety and outcomes of mini-laparoscopic cholecystectomy (MLC).
- To evaluate MLC in children under 10 years old diagnosed with SCD and cholelithiasis.
Main Methods:
- A prospective study included 75 children with SCD under 10 years old.
- Twelve children (16%) with symptomatic gallstones underwent MLC.
- Preoperative anemia correction was performed; operative time, complications, hospital stay, and pain recurrence were recorded.
Main Results:
- The mean operative time for MLC was 46.5 minutes.
- Mean hospital stay was 2.1 days; no patient required an abdominal drain.
- One case of postoperative jaundice due to cholestasis occurred, which resolved with treatment. No recurrent abdominal pain was reported post-MLC.
Conclusions:
- Mini-laparoscopic cholecystectomy is a safe surgical option for pediatric SCD patients with gallstones.
- MLC effectively manages cholelithiasis, leading to a significant decrease in recurrent abdominal pain.
- The procedure improves the overall quality of life for children with SCD.
Background:
Cholelithiasis is very common in patients with sickle cell disease (SCD) and is responsible for recurrent attacks of abdominal pain. The ideal management, especially for children, remains controversial. The purpose of the present study was to evaluate the safety and outcome of mini-laparoscopic cholecystectomy (MLC) in young children under age of 10 years with SCD.
Methods:
A prospective study was carried out of 75 children with SCD under 10 years of age with recurrent abdominal pains seen between August 2001 and March 2004 at Armed Forces Hospital, Khamis Mushayt, Saudi Arabia, who were screened for cholelithiasis. Twelve (16%) of the 75 children were found to have gallstones. The mean age was 7.8 years (range 4-9 years). All 12 children underwent MLC. Anaemia was corrected preoperatively in all the patients. Operative time, intraoperative complications, hospital stay, and postoperative recurrent abdominal pain were recorded.
Results:
The mean operating time was 46.5 min (range: 35-65 min). Intraoperative cholangiogram failed in two children due to narrow cystic ducts. The mean hospital stay was 2.1 days (range: 2-4 days). No patient required intra-abdominal drain. The mean follow-up period was 13.4 months (range: 4-24 months). The only postoperative complication was deep jaundice 1 month postoperatively due to cholestasis, and this responded to medical treatment. None of the children had recurrent abdominal pain after MLC.
Conclusion:
Mini-laparoscopic cholecystectomy is a safe surgical procedure for the management of cholelithiasis in children with SCD and leads to improvement in the quality of life by decreasing the frequency of recurrent abdominal pain.
