Related Experiment Videos
Sequential endoscopic/laparoscopic management of sickle hemoglobinopathy-associated cholelithiasis and suspected
C F Gholson1, J F Grier, M B Ibach
1Department of Medicine, Louisiana State University School of Medicine, Shreveport 71130, USA.
Insights
Sickle hemoglobinopathy patients with gallstones often have common bile duct stones. An increase in bilirubin levels is the best indicator of common bile duct stones, which can be successfully managed with endoscopic and laparoscopic procedures.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Innovation
Background:
- Gallstones (cholelithiasis) are common in sickle hemoglobinopathy.
- Common bile duct stones (choledocholithiasis) can complicate gallstone disease.
Purpose of the Study:
- To evaluate the incidence and management of common bile duct stones in sickle hemoglobinopathy patients undergoing cholecystectomy.
Main Methods:
- Retrospective review of 17 sickle hemoglobinopathy patients.
- Preoperative evaluation including ERCP for suspected choledocholithiasis.
- Laparoscopic cholecystectomy (LC) and endoscopic ductal clearance.
Main Results:
- Choledocholithiasis identified in 18% of patients (3/17).
- Increased hyperbilirubinemia (>5 mg/dL above baseline) was the best predictor of CDL.
- Sequential endoscopic and laparoscopic management was successful.
Conclusions:
- Common bile duct stones are relatively common in sickle hemoglobinopathy patients with cholelithiasis and elevated bilirubin.
- Standard liver function tests are poor predictors of CDL in this population.
- A combined endoscopic and laparoscopic approach is effective for managing cholelithiasis and CDL.
Abstract:
We reviewed the medical records of 17 patients with sickle hemoglobinopathy-associated cholelithiasis who were candidates for laparoscopic cholecystectomy (LC) between 1991 and 1994. Eight patients with suspected choledocholithiasis (CDL) were identified, all of whom had preoperative endoscopic retrograde cholangiopancreatography (ERCP), which revealed CDL in 3 patients (18%), all of whom had endoscopic ductal clearance. Choledocholithiasis was suspected because of hyperbilirubinemia or serum liver enzyme abnormalities. Incremental hyperbilirubinemia exceeding "baseline" values by > 5 mg/dL was the best predictor of CDL. Subsequent LC was successful with discharge within 2 days of LC in all but one patient, who was converted to open cholecystectomy. This small series suggests that in sickle hemoglobinopathy patients with cholelithiasis (1) CDL is relatively common among patients with an increase above baseline hyperbilirubinemia, (2) bile duct dilatation, alkaline phosphatase, and serum aminotransferase levels are poor predictors of CDL, and (3) sequential endoscopic/laparoscopic management of cholelithiasis and suspected CDL is successful.