Related Experiment Videos
Laparoscopic cholecystectomy in children with sickle cell anemia and the role of ERCP
Ahmed Hassan Al-Salem1, Hussain Issa
1Department of Pediatric Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia. ahsalsalem@hotmail.com
Insights
Laparoscopic cholecystectomy (LC) is a safe and effective treatment for gallstones in children with sickle cell anemia (SCA), showing fewer complications than open surgery. Endoscopic retrograde cholangiopancreatography (ERCP) aids in managing bile duct stones.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hematology
Background:
- Sickle cell anemia (SCA) patients exhibit a high prevalence of gallstones (cholelithiasis) and bile duct stones (choledocholithiasis).
- This study analyzes the efficacy and safety of laparoscopic cholecystectomy (LC) in pediatric SCA patients.
Purpose of the Study:
- To evaluate the outcomes of LC compared to open cholecystectomy (OC) in children with SCA.
- To assess the role of endoscopic retrograde cholangiopancreatography (ERCP) in managing biliary conditions in this patient group.
Main Methods:
- Retrospective review of 94 children with SCA who underwent cholecystectomy between 1995 and 2009.
- Comparison of operative time, hospital stay, and postoperative complications between OC and LC groups.
- Analysis of ERCP utility for diagnosis and treatment of choledocholithiasis.
Main Results:
- LC group had significantly fewer postoperative complications (7.7%) compared to the OC group (22.9%).
- LC demonstrated shorter hospital stays and better postoperative recovery.
- ERCP was valuable preoperatively and postoperatively, with a sequential approach of ERCP and LC proving effective.
Conclusions:
- Laparoscopic cholecystectomy is the preferred surgical approach for gallstones in children with SCA due to superior outcomes.
- ERCP is a crucial tool for diagnosing and treating bile duct stones in conjunction with LC.
- The combined ERCP-LC strategy offers a safe and effective management for cholelithiasis and choledocholithiasis in pediatric SCA.
Background:
Patients with sickle cell anemia (SCA) have a high incidence of cholelithiasis and choledocholithiasis. This report is an analysis of our experience with laparoscopic cholecystectomy (LC) for children with SCA and the role of endoscopic retrograde cholangiopancreatography (ERCP).
Patients And Methods:
The records of children with SCA who had cholecystectomy were retrospectively reviewed for age, sex, hemoglobin level, hemoglobin electrophoresis, indication for cholecystectomy, operative time, hospital stay, and postoperative complications. They were divided into 2 groups, open cholecystectomy (OC) group and LC group, and the 2 were compared in terms of operative time, hospital stay, and postoperative complications.
Results:
Over a period of 15 years (January 1995 and December 2009), 94 children with SCA had cholecystectomy. Thirty-five (19 males and 16 females) had OC, 52 (28 males and 24 females) had LC, and 7 (4 males and 3 females) had LC and splenectomy. Their age ranged from 4 to 15 years (mean, 11.4 y). The indications for cholecystectomy were biliary dyspepsia and biliary colic (55), acute cholecystitis (7), obstructive jaundice (17), asymptomatic (12), and biliary pancreatitis (3). All those who had OC underwent intraoperative cholangiogram, 9 of them (25.7%) had common bile duct (CBD) exploration and 2 transduodenal sphincterotomy. Of those who had LC, 13 (25%) underwent preoperative ERCP, which was normal in 1, showed dilated CBD with no stones in 2, and dilated CBD with stones in 7. In 3, ERCP showed dilated CBD with enlarged, inflammed papilla suggestive of recent stone passage. Nine underwent endoscopic sphincterotomy and stone extraction followed by LC. There was no mortality; 1 (2.1%) required conversion to OC and another underwent postoperative exploration because of bleeding from an accessory cystic artery. In the LC group, 4 (7.7%) developed minor postoperative complications, whereas 8 (22.9%) in the OC group developed complications.
Conclusions:
With proper perioperative management, LC is feasible, safe, and superior to OC in children with SCA with regard to postoperative complications, duration of hospital stay, cosmetic appearance, and postoperative recovery. LC should be the treatment of choice for both symptomatic and asymptomatic cholelithiasis in children with SCA. ERCP is a valuable diagnostic and therapeutic investigation both preoperatively and postoperatively. The sequential approach of endoscopic sphincterotomy and stone extraction followed by LC is a safe and effective approach for the management of cholelithiasis and choledocholithiasis in children with SCA.
