Laparoscopic cholecystectomy in adults with sickle cell disease.
BACKGROUND
Chronic hemolysis predisposes adults with sickle cell disease (SCD) to the formation of bilirubinate cholelithiasis.


METHODS
To study the impact of laparoscopic cholecystectomy (LC) on this groups, we reviewed our records of all patients with SCD and cholelithiasis treated electively from 1991 to 1999. During that period, 13 consecutive patients with SCD underwent elective LC for symptomatic cholelithiasis. Nine patients (69.2%) were managed with a preoperative transfusion regimen to achieve a hemoglobin value of >/=10 g/dl, independent of hemoglobin S percentage. Five patients who presented with jaundice were referred for preoperative endoscopic retrograde cholangiopancreatography (ERCP), which identified choledocholithiasis in two of them. Three other patients underwent intraoperative cholangiography, which revealed common bile duct stones in one patient.


RESULTS
One patient developed pyrexia for 2 days. There were no vaso-occlusive crises or deaths. The mean hospital stay was 3.3 days.


CONCLUSIONS
LC has proven to be a safe and efficacious method for the treatment of symptomatic cholelithiasis in this high-risk population. Hematologists are now more willing to refer early, well-prepared patients with SCD and uncomplicated gallbladder disease for elective LC.
Bonatsos
G
G
First Department of Propaedeutic Surgery, Athens University, Hippokration Hospital, 114 Vas. Sofias Avenue, Athens, Greece.
Birbas
K
K
Toutouzas
K
K
Durakis
N
N
D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome