Elective Cholecystectomy Decreases the Morbidity of Cholelithiasis and Cholecystectomy in Pediatric Sickle Cell Disease.

Cholelithiasis frequently occur in sickle cell disease, are easily diagnosed by ultrasound, and are associated with hospital admissions for abdominal pain. Elective cholecystectomy is controversial in sickle cell disease despite small series which suggest that elective cholecystectomy decreases the morbidity of the procedure. Therefore we examined the impact of cholecystectomy on morbidities associated with cholelithiasis and cholecystectomy in sickle cell disease. METHODS: Records of 191 consecutive pediatric sickle cell patients with cholelithiasis who underwent cholecystectomy between January 1999 and May 2009 were retrospectively reviewed. The cholecystectomies were classified into 3 groups 1) elective: no pre-operative symptoms, cholelithiasis on screening ultrasound, pre-planned surgical preparation; 2) symptomatic: pre-operative symptoms of cholelithiasis on ultrasound, pre-planned surgical preparation; 3) emergent: hospitalization for acute cholecystitis symptoms, cholelithiasis on ultrasound, no pre-planned surgical preparation. We compared the morbidity of cholelithiasis and cholecystectomy by examining pre-operative hospitalizations, cholecystectomy hospitalization, and post-operative hospitalizations. RESULTS: Patients with sickle cell disease underwent a total of 191 cholecystectomies over a ten year period: 51 elective, 110 symptomatic, and 30 emergent. Patients who required an emergent cholecystectomy had a longer post-operative hospitalization time than elective cholecystectomy (7.3 vs 4.3 P< 0.001). Prior to hospitalization for the cholecystectomy, patients needing emergent and elective cholecystectomy had similar number of total of hospital admission days (5.2 vs 5.6 P=0.73). However, the emergent cholecystectomy population required more hospital admission days prior to surgery for abdominal pain than the elective patients (1 vs 0.37, P=0.01). After the cholecystectomy, emergent patients required more total hospital admission days (7.2 vs 2.9, P=0.002) and more admission days for abdominal pain (0.5 vs 0.2, P=0.049) than patients that underwent elective cholecystectomy. In 18 patients with the most severe abdominal pain (>2 inpatient admission days) prior to hospitalization for cholecystectomy, 11 (61%) were not admitted after cholecystectomy for pain. Patients receiving chronic blood transfusions prior to surgery had a reduced need for emergent cholecystectomy as compared to non-transfused patients (8% vs 25%, P= 0.056 by chi-square). Patients receiving hydroxyurea had a similar rate of need for an emergent cholecystectomy as compared to patients not on hydroxyurea (22% vs 13% P= NS). No differences in degree of anemia or reticulocytosis were identified in patients requiring emergent vs. elective cholecystectomy (Hb: 8.7 vs 8.6 g/dL; Reticulocyte percent: 10.9% vs 10.4%). The morbidity of patients in the symptomatic cohort was intermediate between the elective and emergent cohorts without demonstrating statistical significance. CONCLUSIONS: This represents the largest reported series of pediatric cholelithiasis and cholecystectomy in sickle cell disease to date. This data strongly suggests that elective cholecystectomy decreases morbidity associated with cholelithiasis and cholecystectomy in sickle cell disease.

No relevant conflicts of interest to declare.