8- LAPAROSCOPIC CHOLECYSTECTOMY IN SICKLE CELL DISEASE: IS IT A SAFE PROCEDURE?

Hashim S Alkhayat,Jassim H Salim,Salim M Albassam,Mohammad M Mohammad

doi:10.33762/bsurg.2011.55121

Abstract

The aim of this trial is to determine the safety of laparoscopic cholecystectomy for treatment of gall bladder stones in patients with sickle cell anemia (a controversial issue). Sixty patients from both sexes, between 19-35 years old with sickle cell anemia, all of them having gall bladder stones were included in this study in Endosurgery Center in Basrah General Hospital. The patients were divided into three groups, group one (19 patients) were selected for laparoscopic cholecystectomy on random preoperative background, the same thing was applied in group two (21 patients) whose patients were subjected to open cholecystectomy while patients in group three (20 patients) were selected for laparoscopic cholecystectomy on conditioned selection. Three mortalities and two serious morbidities were encountered in the group one and one mild morbidity seen in group two and no mortalities or morbidities in group three. Laparoscopic cholecystectomy in sickle cell patients is a debatable issue, an increasing controversy about serious perioperative and postoperative morbidity were mentioned. The procedure itself was accused and an entirely opposed results were emerged from different studies all are debatable. In this study we noticed the big influence of the risk factors, preparation of patients for surgery and the adherence to the principle anesthetic rules on the outcome after laparoscopic cholecystectomy in patients with sickle cell disease. This influence was limited in open procedure. The controversy in the different trials lies on wither the problem is confined to the disease itself or to the surgical method used for cholecystectomy or both. According to the results obtained from our study we believe that both the severity of the disease and the surgical procedure affecting the results, application of intra and post operative protocol (blood transfusion if Hb less than 9gm/dI, rehydration, oxygenation and respecting general anesthesia rules are mandatory for the safety of the patients.

Highlights

Sickle cell disease is due to the presence of an abnormal B-globine chain in HbA (Valine substituted for glutamic acid) resulting in reduced oxygen tension, increased blood viscosity, occlusion of small blood vessels and infarct in many organs
The three groups were exposed to surgery for removal of their gallbladder (Table I): Patients in group one were selected for laparoscopic cholecystectomy on random preoperative bases, only blood transfusion was ordered when Hb level was less than 9 gram% and some anesthetic principles were applied
The same things were applied for group two whose patients were subjected to open cholecystectomy, while patients in group three were selected for laparoscopic chole-cystectomy on conditioned back ground {appreciation of the risk factors (Table II), perioperative hydration, good per operative oxygenation, prophylactic antibiotics, blood transfusion was ordered only when HB level less than 8 gram%}

Summary

Introduction

Sickle cell disease is due to the presence of an abnormal B-globine chain in HbA (Valine substituted for glutamic acid) resulting in reduced oxygen tension, increased blood viscosity, occlusion of small blood vessels and infarct in many organs. Pulmonary infarct can lead to acute chest syndrome, dehydration seems to predispose to sickle cell crisis and acute chest syndrome by increasing the viscosity of blood[1]. Gallstones are frequent complication in patients with haemoglobinopathies because of the repeated bouts of RBC haemolysis leading to an increase in bilirubin excretion and gall stone formation of pigment type[3]. The incidence of gallstones with sickle cell disease increases due to the use of non invasive detection technique (ultrasound vs cholecystogram) and the longer survival of these patients[4]. The development of pigment gallstones in patients with sickle cell disease is age dependant with a

Methods

Results

Conclusion