title: [Perioperative management of laparoscopic cholecystectomy in children with homozygous sickle cell disease].
abstract: OBJECTIVE
  Sickle cell disease is a public health problem in Africa. The aim of this prospective study was to evaluate per and post-operative complications of laparoscopic cholecystectomy in sickle cell children in Senegal.
  
  
  METHODS
  from January 1999 to December 2006, an anesthetic protocol was applied to 39 sickle cell children undergoing a cholecystectomy. Among them, 20 experienced laparoscopic cholecystectomy.
  
  
  RESULTS
  All these 20 patients had previously suffered from sickle cell visceral complications and were classified as ASA II (11 cases) and as ASA III (9 cases). Blood transfusion program aimed at sustaining haemoglobin level between 10 and 12 g/dl was implemented. The preoperative monitoring and anesthesia management were the same for these patients. During perioperative period, the prevention of pain, hypovolemia, hypothermia and acidosis was achieved. The mean insufflation duration of laparoscopy was 23 min (17-60 min), the mean surgery duration was 55 min (40-110 min), and the mean anesthesia duration was 78 min (88-135 min). Postoperative complications occurred in 9 patients: acute chest syndrome (n=2), postoperative hemolysis (n=5), vaso-occlusive crisis (n=2).
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy can be carried out in sickle cell children affected with gallstones, provided that general anaesthetic rules were respected. An appropriate pre-, per- and postoperative anaesthesia is mandatory to reduce postoperative complications in children with sickle cell disease. Searching for early diagnosis of gallstones before occurrence of visceral complications should allow further optimal laparoscopic surgery.
authors.affiliation: Résidence des médecins étrangers, CHU Nord, rue des Bourrely, 13015 Marseille, France. marie.ndoye@sentoo.sn
authors.forename: M Diop
authors.initials: MD
authors.lastname: Ndoye
authors.forename: M Diao
authors.initials: MD
authors.lastname: Bah
authors.forename: I Ndiaye
authors.initials: IN
authors.lastname: Pape
authors.forename: E
authors.initials: E
authors.lastname: Diouf
authors.forename: O
authors.initials: O
authors.lastname: Kane
authors.forename: M
authors.initials: M
authors.lastname: Bèye
authors.forename: B
authors.initials: B
authors.lastname: Fall
authors.forename: B
authors.initials: B
authors.lastname: Ka-Sall