Prachi Mahajan, MS, FRCS, FMAS, FIAGES. Mahajan ortho and surgical hospital
Vidarbha region of Central India hosts a large population suffering from sickle cell disease ( SCD). Patients may be divided into 2 categories depending upon whether they harbour the sickle cell trait ' SA' pattern or ' SS' haemoglobinopathy. 25% of people suffering from either condition have gallstones due to haemolysis owing to polymerization of the HbS within the Red Blood Cells and sequestration of RBC's in the spleen. This leads to the formation of pigment stones in the gall bladder.
Most of the patients have symptoms such as chronic right upper quadrant with intermittent pain acute exacerbations. Patients may be jaundiced due to the chronic haemolysis and also have bouts of obstructive jaundice from calculi that may intermittently slip into the common bile duct unless treated.
Materials and Methods: 70 patients with cholelithiasis were studied over 5 years. 42 patients had sickle cell trait while 28 had 'SS' disease. The age range was between 15-40 years, with a mean age of 24 years. All the patients had symptoms of chronic cholecystitis. Mean bilirubin was 4.8 mg/DL Laparoscopy revealed characteristic features of chronic cholecystitis in all patients. The gall bladders were small, shrunken, thick walled and contained multiple pigmented calculi.
The technical difficulties were as follows:
1) Very small size of gall bladder in all (100%) patients.
2) Chronic adhesions in the Calot's triangle in 75% of patients.
3) Thickened short contracted cystic duct in 90% of patients.
4) Impacted stones at the neck, causing difficulty in dissection (20%)
5) Intrahepatic gall bladder (25%) Results: Subtotal cholecystectomy had to be performed in 3 cases due to severe adhesions in the Calot’s triangle.
Post operative complications: Sickle cell crisis- acute chest syndrome, joint painsin 3 cases Extended hospital stay of over 5 days in 15 patients due to SCD related complications. Port infection in 4 patients. Mortality in 1 patient due to sickle cell crisis.
Conclusion:
1) Laparoscopic cholecystectomy is technically difficult in patients with sickle cell conditions due to chronic inflammatory changes in the area.
2) Meticulous pre and post operative care is mandatory with adequate fluid infusions, good oxygenation, maintenance of OR temperature above 25 degrees Celsius, pre operative folic acid, sodium bicarbonate, hydroxyurea to prevent hypoxaemia, dehydration and hypothermia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94417
Program Number: P212
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster