title: Elective cholecystectomy in children with sickle hemoglobinopathies. Successful outcome using a preoperative transfusion regimen.
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.
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710.
authors.forename: R
authors.initials: R
authors.lastname: Ware
authors.forename: H C
authors.initials: HC
authors.lastname: Filston
authors.forename: W H
authors.initials: WH
authors.lastname: Schultz
authors.forename: T R
authors.initials: TR
authors.lastname: Kinney
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications*; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography; D002763:Cholecystectomy; D002764:Cholecystitis / Q000209:etiology / Q000601:surgery; D002769:Cholelithiasis / Q000209:etiology / Q000601:surgery*; D017707:Erythrocyte Transfusion; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay; D008297:Male; D011300:Preoperative Care