Laparoscopic cholecystectomy in adults with sickle cell disease

Background: Chronic hemolysis predisposes adults with sickle cell disease ( SCD) to the formation of bilirubinate cholelithiasis. Methods: To study the impact of laparoscopic cholecystectomy (LC) on this g roups, we reviewed our records of all patients with SCD and cholelithiasis treated electively from 1991 to 1999. During that period, 13 consecutive pa tients with SCD underwent elective LC for symptomatic cholelithiasis. Nine patients (69.2%) were managed with a preoperative transfusion regimen to ac hieve a hemoglobin value of greater than or equal to 10 g/dl, independent o f hemoglobin S percentage. Five patients who presented with jaundice were r eferred for preoperative endoscopic retrograde cholangiopancreatography (ER CP), which identified choledocholithiasis in two of them. Three other patie nts underwent intraoperative cholangiography, which revealed common bile du ct stones in one patient. Results: One patient developed pyrexia for 2 days. There were no vaso-occlu sive crises or deaths. The mean hospital stay was 3.3 days. Conclusions: LC has proven to be a safe and efficacious method for the trea tment of symptomatic cholelithiasis in this high-risk population. Hematolog ists are now more willing to refer early, well-prepared patients with SCD a nd uncomplicated gallbladder disease for elective LC.