SEQUENTIAL ENDOSCOPIC LAPAROSCOPIC MANAGEMENT OF SICKLE HEMOGLOBINOPATHY-ASSOCIATED CHOLELITHIASIS AND SUSPECTED CHOLEDOCHOLITHIASIS

We reviewed the medical records of 17 patients with sickle hemoglobino pathy-associated cholelithiasis who were candidates for laparoscopic c holecystectomy (LC) between 1991 and 1994. Eight patients with suspect ed choledocholithiasis (CDL) were identified, all of whom had preopera tive endoscopic retrograde cholangiopancreatogaphy (ERCP), which revea led CDL in 3 patients (18%), all of whom had endoscopic ductal clearan ce. Choledocholithiasis was suspected because of hyperbilirubinemia or serum liver enzyme abnormalities. Incremental hyperbilirubinemia exce eding ''baseline'' values by > 5 mg/dL was the best predictor of CDL. Subsequent LC was successful with discharge within 2 days of LC in all but one patient, who was converted to open cholecystectomy. This smal l series suggests that in sickle hemoglobinopathy patients with cholel ithiasis (1) CDL is relatively common among patients with an increase above baseline hyperbilirubinemia, (2) bile duct dilatation, alkaline phosphatase, and serum aminotransferase levels are poor predictors of CDL, and (3) sequential endoscopic/laparoscopic management of cholelit hiasis and suspected CDL is successful.