Perioperative management in children with sickle cell disease undergoing laparoscopic surgery.
OBJECTIVE
The aim of this study was to evaluate our experience with laparoscopic surgery in children with sickle cell disease.


METHODS
A retrospective chart review was performed to analyze the indication for surgery, perioperative management, surgical technique, complications, duration of hospitalization, and outcome. One pediatric surgeon performed all procedures.


RESULTS
Thirteen children underwent laparoscopic surgery for the following indications: symptomatic cholelithiasis/cholecystitis in 9; recurrent splenic sequestration in 3; and hypersplenism/symptomatic cholelithiasis in 1. The 7 boys and 6 girls had a median age of 7.8 years. Patients undergoing splenectomy only were younger than those undergoing cholecystectomy (median age, 3.6 years versus 11.5 years, respectively). Four children underwent endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy because of common bile duct dilatation and stones. Twelve patients received packed red blood cell transfusions prior to surgery. The median operative time was 150 minutes, and the median hospitalization was 3 days. Four patients suffered postoperative complications (2 with acute chest syndrome, 1 with recurrent abdominal pain, and 1 with priapism). The patient with abdominal pain was found to have a retained stone in the common bile duct, which was retrieved via endoscopic retrograde cholangiopancreatography and sphincterotomy. All complications resolved with medical management.


CONCLUSIONS
Laparoscopic surgery is safe in children with sickle cell disease. Meticulous attention to perioperative management, transfusion guidelines, and pulmonary care may decrease the incidence of acute chest syndrome.
Sandoval
Claudio
C
Department of Pediatrics, New York Medical College, Westchester Medical Center, Valhalla 10595, USA.
Stringel
Gustavo
G
Ozkaynak
M Fevzi
MF
Tugal
Oya
O
Jayabose
Somasundaram
S
D000755:Anemia, Sickle Cell / Q000150:complications; D001803:Blood Transfusion; D002648:Child; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications; D011300:Preoperative Care; D012189:Retrospective Studies; D013156:Splenectomy; D013163:Splenomegaly / Q000150:complications / Q000601:surgery