Acute chest syndrome after abdominal surgery in children with sickle cell disease: Is a laparoscopic approach better?

Background/Purpose: Acute chest syndrome (ACS) is the leading cause of hosp italization and death among patients with sickle cell disease (SCD). Surger y is a risk factor for the development of ACS. It has been suggested that l aparoscopic surgery could diminish the risk of sickle-related complications ; therefore, more procedures may be encouraged in asymptomatic patients. Th e goal of the authors was to determine the incidence of postoperative ACS a nd assess for predisposing factors in all sickle cell patients undergoing a bdominal surgery. Methods: A retrospective analysis of all sickle cell patients receiving abd ominal surgery (open and laparoscopic) between 1994 and 1998 was conducted. Data pertaining to demographics, perioperative clinical status, postoperat ive care, and outcome were collected and analyzed using Student's t test or chi (2) where appropriate. Results: Fifty-four children underwent 62 procedures (35 abdominal and 27 e xtracavitary). All abdominal cases were either cholecystectomy or splenecto my (22 laparoscopic and 13 open). ACS occurred in 7 of 62 (11.3%) overall, and all were in abdominal cases 7 of 35 (20%). ACS occurred in 5 of 22 (22. 7%) laparoscopic cases and 2 of 13 (15.4%) open cases. Operating lime was s ignificantly longer in the laparoscopic group compared with open cases (P < .05). A higher percentage of patients who had ACS had at least 1 previous e pisode (71.4% v 39.3%; P value not significant) and a smaller percentage of ACS patients received a preoperative blood transfusion (14.3% V 32.1%; P v alue not significant). Postoperative hospitalization was prolonged if ACS o ccurred (9 +/- 2 v 3 +/- 2 days; P<.05). Conclusions: Abdominal surgery carries a significantly high risk (20%) of A CS. Laparoscopy does not decrease the incidence of ACS compared with open a pproach. Predisposing factors were not significant in predicting postoperat ive ACS. There is considerable morbidity and potential cost implications in patients with ACS. J Pediatr Surg 36:718-721. Copyright (C) 2001 by W.B. S aunders Company.