Laparoscopic versus open abdominal surgery in children with sickle cell disease is associated with a shorter hospital stay.
BACKGROUND
Limited information exists comparing the post-operative complication rate of laparoscopic or open abdominal surgeries in children with sickle cell disease (SCD). The primary objective of this study was to compare the outcomes in children with SCD who required laparoscopic or open abdominal surgery for a cholecystectomy or splenectomy.


METHODS
We conducted a retrospective analysis of laparoscopic and open abdominal surgeries performed in children with SCD (ages 0-20 years) at two medical centers from 1984 to 2004. The primary outcome measures were the rates of post-operative pain and acute chest syndrome (ACS) episodes following laparoscopic or open abdominal surgery. The secondary outcome was length of hospital stay following surgery. We also examined the potential contribution of pre-operative (transfusion) and intra-operative factors (operating time, estimated blood loss, and end-operative temperature) to post-operative SCD-related complications.


RESULTS
A total of 140 cases were identified, 98 laparoscopic and 42 open. Episodes of post-operative pain and ACS episodes were comparable between laparoscopic and open procedures (pain: 4% vs. 3%, P = 0.619; ACS: 5% vs. 5%, P = 0.933). Additionally, laparoscopic surgeries were associated with a significantly shorter hospital stay (2.9 vs. 5.4 days, 95% CI -3.7 to -1.4, P < 0.001). There was no difference in the number of hospital readmissions within 1 month of the surgery.


CONCLUSIONS
For children with SCD who need a cholecystectomy or splenectomy, laparoscopy is the preferred strategy because of a shorter hospital stay with a similar complication rate compared to open surgeries.
Goers
Trudie
T
Department of General Surgery, Washington University, St. Louis, Missouri, USA.
Panepinto
Julie
J
Debaun
Michael
M
Blinder
Morey
M
Foglia
Robert
R
Oldham
Keith T
KT
Field
Joshua J
JJ
D000208:Acute Disease; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001831:Body Temperature; D002637:Chest Pain / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010149:Postoperative Pain / Q000453:epidemiology; D011300:Preoperative Care; D013156:Splenectomy / Q000379:methods / Q000706:statistics & numerical data*; D013577:Syndrome