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Laparoscopic cholecystectomy for cholelithiasis in children with sickle cell disease
Yousef Al Talhi1, Bader Hamza Shirah2, Muteb Altowairqi3
1King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Sciences, P.O. Box: 65362, Jeddah, 21556, Saudi Arabia.
Insights
Pediatric patients with sickle cell disease (SCD) have a higher risk of gallstones. This review examines the safety and effectiveness of laparoscopic cholecystectomy (LC) for gallstone management in these children.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Oncology
Background:
- Sickle cell disease (SCD) patients experience increased hemolysis, leading to elevated bilirubin and pigment gallstone formation.
- Laparoscopic cholecystectomy (LC) is the standard for gallstone disease due to its minimally invasive benefits.
- Evidence on LC safety and efficacy in pediatric SCD patients with gallstones is limited, with unresolved controversies.
Purpose of the Study:
- To comprehensively review existing literature on gallstone management in pediatric SCD patients.
- To propose evidence-based recommendations for the optimal surgical approach.
- To address the current practice variations based on geographic SCD prevalence.
Main Methods:
- Systematic review of published literature on laparoscopic cholecystectomy for gallstones in pediatric sickle cell disease patients.
- Analysis of reported outcomes, complications, and benefits.
- Synthesis of findings to inform practice recommendations.
Main Results:
- Gallstone formation is a significant complication in pediatric SCD patients due to chronic hemolysis.
- LC offers advantages but its specific application in pediatric SCD requires further investigation.
- Current management strategies vary, highlighting a need for standardized evidence-based guidelines.
Conclusions:
- Further evidence-based studies are needed to establish definitive recommendations for LC in pediatric SCD patients with gallstones.
- Addressing the limited patient data and lack of randomized trials is crucial.
- Standardizing management will improve outcomes for this vulnerable population.
Abstract:
Patients with sickle cell disease (SCD) suffer from an increased incidence of gallstone formation due to hemolysis of sickled red blood cells; this leads to an increased level of bilirubin in secreted bile that becomes a nidus for pigment stone formation. Laparoscopic cholecystectomy (LC) is considered a standard operative procedure for gallstone disease mainly due to lower postoperative wound complaints, faster recovery, better postoperative cosmetic results, shorter hospital stay, and earlier return to work. Although numerous studies have been published addressing both the advantages and complications of LC in acute calcular cholecystitis, there is still limited evidence concerning the safety and efficacy of LC for the management of cholelithiasis in pediatric patients with SCD, and controversies remain unresolved. In this review, we aim to comprehensively study the available literature and propose evidence-based practice recommendations for the optimal management of gallstones in pediatric SCD patients. The current practice differs greatly depending on the prevalence of SCD in a particular geographic area. We acknowledge the limited number of patients reported, the lack of randomized control trials addressing the practice of specific recommendations, and the need for further evidence-based studies.
