title: Acute chest syndrome after laparoscopic splenectomy in children with sickle cell disease: operative time dependent?
abstract: BACKGROUND
  Laparoscopic splenectomy remains a technically demanding procedure. On patients with sickle cell disease (SCD), a post operative acute chest syndrome (ACS) can occur. The aim of the study was to look for predictive factors of post operative ACS.
  
  
  METHODS
  It's a retrospective study on patients with SCD, who underwent a laparoscopic splenectomy in Robert Debré hospital, Paris, France, between March 2008 and December 2013. Diagnosis of ACS was done if the patient developed hypoxemia associated with fever above 38.5 °C and an infiltrate on chest x ray during the post operative course. Pre-, post- and operative factors were studied. Descriptive statistics were compared using the Mann-Whitney test or the exact Fisher test. A p inferior to 0.05 was considered as significant.
  
  
  RESULTS
  52 patients with SCD underwent a laparoscopic splenectomy. Twelve patients presented a post operative ACS (23%) (mean age at surgery 4 years old) while forty did not (mean age 5.25 years old). Neither previous episode of ACS nor any factors reflecting SCD severity were significant. The shorter the operative time was, the greater the risk of developing an ACS (p < 0.05).
  
  
  CONCLUSIONS
  ACS is an important complication following laparoscopic splenectomy in patients with SCD. The immediate post operative management, in the absence of predictive factors for ACS, should be carefully followed in a high dependency unit at least for 48 h for all patients.
authors.affiliation: Department of General Pediatric Surgery and Pediatric Urology, Robert Debré Hospital and Paris VII University, APHP, 48 Boulevard Serurier, 75019, Paris, France, arnaud.bonnard@rdb.aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Bonnard
authors.forename: M
authors.initials: M
authors.lastname: Masmoudi
authors.forename: B
authors.initials: B
authors.lastname: Boimond
authors.forename: C
authors.initials: C
authors.lastname: Capito
authors.forename: L
authors.initials: L
authors.lastname: Holvoet
authors.forename: A
authors.initials: A
authors.lastname: Skhiri
authors.forename: A
authors.initials: A
authors.lastname: El Ghoneimi
mesh_terms: D056586:Acute Chest Syndrome / Q000453:epidemiology; D000755:Anemia, Sickle Cell / Q000453:epidemiology* / Q000601:surgery*; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005602:France; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013156:Splenectomy / Q000009:adverse effects*