Related Experiment Videos
Elective cholecystectomy in children with sickle hemoglobinopathies. Successful outcome using a preoperative
R Ware1, H C Filston, W H Schultz
1Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Elective cholecystectomy is safe for children with sickle cell disease when using a preoperative transfusion regimen. This approach minimizes perioperative complications and ensures safe surgical management for gallstones.
Area of Science:
- Pediatric Surgery
- Hematology
- Gastroenterology
Background:
- Sickle cell disease (SCD) poses risks for surgical procedures.
- Cholelithiasis is common in children with SCD.
- Elective surgery in SCD patients requires careful management.
Purpose of the Study:
- To evaluate the safety and efficacy of elective cholecystectomy in children with major sickle hemoglobinopathies.
- To assess the impact of a specific preoperative transfusion regimen on perioperative outcomes.
Main Methods:
- Twenty-seven children with sickle hemoglobinopathies underwent elective cholecystectomy.
- Preoperative transfusion aimed for hemoglobin 11-14 g/dl and >65% hemoglobin A.
- Intraoperative cholangiography and incidental appendectomy were performed.
Main Results:
- No vaso-occlusive events or perioperative morbidity/mortality were observed.
- Common bile duct stones were found in 5 patients (1 diagnosed preoperatively).
- One late small bowel obstruction occurred; no transfusion-acquired infections or significant allosensitization.
Conclusions:
- A preoperative transfusion regimen and meticulous perioperative care enable safe elective cholecystectomy in pediatric SCD patients.
- This strategy effectively reduces surgical risks associated with sickle cell disease.
- Further vigilance for late complications like bowel obstruction is warranted.
Abstract:
Twenty-seven children with major sickle hemoglobinopathies underwent elective cholecystectomy for cholelithiasis. All were managed with a preoperative transfusion regimen to achieve a hemoglobin concentration of 11-14 g/dl with greater than 65% hemoglobin A. Intraoperative cholangiography revealed common bile duct stones in five patients, although only one case was diagnosed by preoperative ultrasonographic examination. Twenty-four children underwent incidental appendectomy by total intussusception. There were no vaso-occlusive events nor any other perioperative morbidity or mortality. Four months after cholecystectomy, one boy had a small bowel obstruction requiring surgical re-exploration. No patients had transfusion-acquired infection, although one boy had erythrocyte allosensitization to Lewis A antigen. This preoperative transfusion regimen and careful perioperative management permits safe elective cholecystectomy in children with sickle cell disease.