title: A nontransfusional perioperative management regimen for patients with sickle cell disease undergoing laparoscopic cholecystectomy.
abstract: BACKGROUND
  Patients with sickle cell disease (SCD) are at increased risk for cholelithiasis. Laparoscopic cholecystectomy is the most frequent general surgical operation performed for this group of patients. Acute chest syndrome (ACS) is the most common cause of postoperative death among SCD patients. This study aimed to evaluate the impact of a novel perioperative management regimen involving prophylactic continuous positive airways pressure (CPAP) ventilation and avoidance of preoperative blood transfusion on postoperative SCD-related complications after laparoscopic cholecystectomy.
  
  
  METHODS
  A retrospective study included all SCD patients who underwent laparoscopic cholecystectomy since 1997 at our institution. Medical notes were analyzed to assess the rates of postoperative complications in relation to the severity of SCD.
  
  
  RESULTS
  A total of 13 patients were identified. There were no recorded episodes of acute painful crises and only one patient experienced an episode of ACS requiring protracted CPAP.
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy can be safely performed for SCD patients without prior blood transfusion. A defined perioperative regimen including the use of routine postoperative prophylactic CPAP for these patients helps to reduce SCD-related postoperative complications such as ACS and painful vaso-occlusive crises.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College, London, UK. d.leff@imperial.ac.uk
authors.forename: D R
authors.initials: DR
authors.lastname: Leff
authors.forename: T
authors.initials: T
authors.lastname: Kaura
authors.forename: T
authors.initials: T
authors.lastname: Agarwal
authors.forename: S C
authors.initials: SC
authors.lastname: Davies
authors.forename: J
authors.initials: J
authors.lastname: Howard
authors.forename: A C
authors.initials: AC
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000175:diagnosis; D001803:Blood Transfusion; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002769:Cholelithiasis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006403:Hematologic Tests; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome