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Experience of splenectomy and cholecystectomy in children with chronic haemolytic anaemia
C H Pappis1, S Galanakis, G Moussatos
1First Paediatric Surgery Department, Aghia Sophia Children's Hospital, Athens, Greece.
Insights
Screening for gallstones before splenectomy is crucial for children with chronic hemolytic anemia. Early detection of asymptomatic gallstones allows for timely, simultaneous gallbladder removal, improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Hematology
- Gastroenterology
Background:
- Chronic hemolytic anemias often necessitate splenectomy in pediatric patients.
- Cholelithiasis (gallstones) is a common comorbidity in these patients, sometimes asymptomatic.
- Previous management involved staged or simultaneous splenectomy and cholecystectomy based on symptoms.
Purpose of the Study:
- To evaluate the incidence of cholelithiasis in children undergoing splenectomy for chronic hemolytic anemia.
- To assess the optimal timing and approach for cholecystectomy in relation to splenectomy.
- To determine the benefits of screening for gallstones prior to splenectomy.
Main Methods:
- Retrospective analysis of 419 children with chronic hemolytic anemia who underwent splenectomy since 1973.
- Review of concurrent or subsequent cholecystectomy rates and indications (symptomatic vs. asymptomatic with sonographic findings).
- Comparison of surgical approaches between two periods: 1973-1982 (symptomatic) and 1983-1987 (sonography-guided screening).
Main Results:
- 53 children (12.6%) required cholecystectomy due to cholelithiasis.
- In the later period, simultaneous splenectomy and cholecystectomy increased, particularly in patients with sickle cell disease (41%) and spherocytosis (22.2%).
- A significant incidence of asymptomatic cholelithiasis was identified through sonographic screening.
Conclusions:
- There is a high prevalence of asymptomatic gallstones in pediatric patients with chronic hemolytic anemia.
- Pre-splenectomy screening for gallstones is recommended to identify subclinical cholelithiasis.
- Simultaneous cholecystectomy should be considered for patients with confirmed gallstones undergoing splenectomy.
Abstract:
Since 1973, 419 children (233 boys, 186 girls) with chronic haemolytic anaemia (mean age, 10.2 +/- 3.5 years) have been splenectomised. Fifty-three (12.6%) have also been cholecystectomised because of cholelithiasis. Between 1973 and 1982, cholecystectomy and splenectomy were performed at the same time in symptomatic patients. Later, between 1983 and 1987, cholecystectomy was also performed in clinically asymptomatic patients with positive sonographic findings. In the first period, 11 thalassaemic patients (45.8%) were cholecystectomised a short period after splenectomy (in two cases, only 2 and 3 weeks later). Between 1983 and 1987, when asymptomatic patients with cholelithiasis were screened by sonography, simultaneous cholecystectomy and splenectomy were performed in 13.6% of the patients with thalassaemia, in 41% of the patients with sickle cell or microdrepanocytic disease, and in 22.2% of the patients with spherocytosis. As there is a high incidence of asymptomatic cholelithiasis and hypersplenism in patients with chronic haemolytic anaemia, screening for gallstones should precede splenectomy. Simultaneous cholecystectomy should be performed in patients with cholelithiasis.