1
|
Zeineddin A, Cornwell EE, Fullum TM, Chu QD, Kearse L, Ayad MH, Li S, Williams M. Early Cholecystectomy in Patients with Sickle Cell Disease with Uncomplicated Cholelithiasis Is Associated with Better Outcomes. J Am Coll Surg 2024; 238:543-550. [PMID: 38193560 DOI: 10.1097/xcs.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Up to 85% of patients with sickle cell disease (SCD) will develop gallstones by their third decade. Cholecystectomy is the most commonly performed procedure in these patients. Cholecystectomy is recommended for patients with SCD with symptomatic cholelithiasis and leads to lower morbidity. No contemporary large studies have evaluated this recommendation or associated clinical outcomes. This study evaluates clinical outcomes after cholecystectomy in patients with SCD and cholelithiasis with specific advanced clinical presentations. STUDY DESIGN The Nationwide Inpatient Sample was queried for patients with SCD and gallbladder disease between 2006 and 2015. Patients were divided into groups based on their disease presentation, including uncomplicated cholelithiasis, acute and chronic cholecystitis, and gallstone pancreatitis. Clinical outcomes associated with disease presentation were analyzed. Statistical analysis was performed using the Student's t -test, chi-square test, ANOVA, and logistic regression. RESULTS There were 6,662 patients with SCD who presented with cholelithiasis. Median age was 20 (interquartile range 16 to 34) years and 54% were female patients. Cholecystectomy was performed in 1,779 patients with SCD with the most common indication being chronic cholecystitis (44%), followed by uncomplicated cholelithiasis (27%), acute cholecystitis (21%), and choledocholithiasis or gallstone pancreatitis (8%). On multivariable regression, advanced clinical presentation was the strongest predictor of perioperative vaso-occlusive crisis, which was the most common complication. Patients undergoing cholecystectomy for uncomplicated cholelithiasis were at lower risk than those with acute cholecystitis (odds ratio [OR] 2.37; 95% CI 1.64 to 3.41), chronic cholecystitis (OR 1.74; 95% CI 1.26 to 2.4), and choledocholithiasis or gallstone pancreatitis (OR 2.24; 95% CI 1.41 to 3.57). CONCLUSIONS Seventy-three percent of patients with SCD have advanced clinical presentation at the time of their cholecystectomy. After cholecystectomy, perioperative vaso-occlusive events were significantly increased in patients with advanced clinical presentation. These data support screening abdominal ultrasounds and early cholecystectomy for cholelithiasis in patients with SCD.
Collapse
Affiliation(s)
- Ahmad Zeineddin
- From the Department of Surgery, Howard University College of Medicine, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Ayad, Li, Williams)
- Clive O Callender Surgery Outcomes Center, Howard University, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Williams)
| | - Edward E Cornwell
- From the Department of Surgery, Howard University College of Medicine, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Ayad, Li, Williams)
- Clive O Callender Surgery Outcomes Center, Howard University, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Williams)
| | - Terrence M Fullum
- From the Department of Surgery, Howard University College of Medicine, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Ayad, Li, Williams)
- Clive O Callender Surgery Outcomes Center, Howard University, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Williams)
| | - Quyen D Chu
- From the Department of Surgery, Howard University College of Medicine, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Ayad, Li, Williams)
- Clive O Callender Surgery Outcomes Center, Howard University, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Williams)
| | - LaDonna Kearse
- Department of Surgery, Mayo Clinic, Rochester, MN (Kearse)
| | - Marco H Ayad
- From the Department of Surgery, Howard University College of Medicine, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Ayad, Li, Williams)
| | - Sandy Li
- From the Department of Surgery, Howard University College of Medicine, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Ayad, Li, Williams)
| | - Mallory Williams
- From the Department of Surgery, Howard University College of Medicine, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Ayad, Li, Williams)
- Clive O Callender Surgery Outcomes Center, Howard University, Washington, DC (Zeineddin, Cornwell III, Fullum, Chu, Williams)
| |
Collapse
|
2
|
Lee BJH, Yap QV, Low JK, Chan YH, Shelat VG. Cholecystectomy for asymptomatic gallstones: Markov decision tree analysis. World J Clin Cases 2022; 10:10399-10412. [PMID: 36312509 PMCID: PMC9602237 DOI: 10.12998/wjcc.v10.i29.10399] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
Gallstones are a common public health problem, especially in developed countries. There are an increasing number of patients who are diagnosed with gallstones due to increasing awareness and liberal use of imaging, with 22.6%-80% of gallstone patients being asymptomatic at the time of diagnosis. Despite being asymptomatic, this group of patients are still at life-long risk of developing symptoms and complications such as acute cholangitis and acute biliary pancreatitis. Hence, while early prophylactic cholecystectomy may have some benefits in selected groups of patients, the current standard practice is to recommend cholecystectomy only after symptoms or complications occur. After reviewing the current evidence about the natural course of asymptomatic gallstones, complications of cholecystectomy, quality of life outcomes, and economic outcomes, we recommend that the option of cholecystectomy should be discussed with all asymptomatic gallstone patients. Disclosure of material information is essential for patients to make an informed choice for prophylactic cholecystectomy. It is for the patient to decide on watchful waiting or prophylactic cholecystectomy, and not for the medical community to make a blanket policy of watchful waiting for asymptomatic gallstone patients. For patients with high-risk profiles, it is clinically justifiable to advocate cholecystectomy to minimize the likelihood of morbidity due to complications.
Collapse
Affiliation(s)
- Brian Juin Hsien Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore S308232, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore S117597, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore S308433, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore S117597, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore S308433, Singapore
| |
Collapse
|
3
|
Attalla BAI, Karrar ZA, Ibnouf G, Mohamed AO, Abdelwahab O, Nasir EM, El Seed MA. Outcome of cholelithiasis in Sudanese children with Sickle Cell Anaemia (SCA) after 13 years follow-up. Afr Health Sci 2013; 13:154-9. [PMID: 23658582 PMCID: PMC3645102 DOI: 10.4314/ahs.v13i1.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND SCA causes chronic haemolysis which is a risk factor for cholelithiasis. OBJECTIVE To determine the prevalence and outcome of children with SCA complicated with gallstones treated at the sickle cell clinic at the children emergency hospital Khartoum state. METHODS 261 patients age 4 months to 16 years were studied. AUS examination was carried out. The 30 patients in whom gall stones were detected followed prospectively from June 1996 to September 2009 when a second AUS examination was obtained. RESULTS Gall stones occurred in 30 patients of whom four were lost to follow up in the first year. The overall prevalence of cholelithiasis was 11.5% and it increased with age. The youngest patient with cholelithiasis was 2 1/2 years old. Haematological variables, bilirubin and sex did not identify a subgroup of patients at higher risk for gallstones. All the patients were asymptomatic at the time of diagnosis. One patient developed symptoms 3years after the diagnosis and he was submitted to surgery. The 25 remaining asymptomatic patients were followed up for 13 years and none of them presented complications related to cholelithiasis during this period. CONCLUSION The prevalence of cholelithiasis in Sudanese children and adolescents with SCA was significant. The large majority patients remained asymptomatic over a long period.
Collapse
Affiliation(s)
- B A I Attalla
- Department of Paediatrics, University of Bahri, Khartoum, Sudan.
| | | | | | | | | | | | | |
Collapse
|
4
|
Comparative effectiveness of different types of splenectomy for children with congenital hemolytic anemias. J Pediatr 2012; 160:684-689.e13. [PMID: 22050869 DOI: 10.1016/j.jpeds.2011.09.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/31/2011] [Accepted: 09/19/2011] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare the effectiveness of different types of splenectomy in children with congenital hemolytic anemias. STUDY DESIGN We constructed key questions that addressed outcomes relevant to clinicians and families on effects of partial or total splenectomy, including hematologic effect, splenic function, and the risk of adverse events. We identified from Pubmed and Embase 703 studies that evaluated different types of splenectomy and accepted 93 studies that satisfied entry criteria. We graded the quality of each report and summarized the overall strength of research evidence for each key question. RESULTS We did not identify any randomized clinical trials. All types of splenectomy have favorable clinical outcomes in most diseases. We did not identify any hematologic advantage of laparoscopy compared with laparotomy. Adverse events are uncommon in most studies and are minimized with use of laparoscopy. CONCLUSIONS There is a need for randomized clinical trials and improved data collection of different types of splenectomy in congenital hemolytic anemias. Outcomes studied should address the concerns of families and clinicians to assess the risks and benefits of various treatments.
Collapse
|
5
|
Abstract
CONTEXT little is known about the epidemiology of cholelithiasis in children. Cholelithiasis and choledocholithiasis were considered to be uncommon in infants and children but have been increasingly diagnosed in recent years due to wide- spread use of ultrasonography. However, there is not much of information from India and no consensus among Indian pediatricians and pediatric surgeons regarding management of gallstones in children. Hence, the purpose of this review is to increase awareness about the management of gallstones in children. METHODS extensive electronic (PubMed) literature search was made for this purpose and literature (original articles, clinical trials, case series, review articles) related to gallstones in children were reviewed. CONCLUSIONS the etiologies of cholelithiasis are hemolytic (20% -30%), other known etiology (40%-50%) such as total parenteral nutrition, ileal disease, congenital biliary diseases, and idiopathic (30-40 %). Spontaneous resolution of gallstones is frequent in infants and hence a period of observation is recommended even for choledocholithiasis. Children with gallstones can present with typical biliary symptoms (50%), nonspecific symptoms (25%), be asymptomatic (20%) or complicated (5% -10%). Cholecystectomy is useful in children with typical biliary symptoms but is not recommended in those with non-specific symptoms. Prophylactic cholecystectomy is recommended in children with hemolytic disorders.
Collapse
|
6
|
Pal K. Modified port placement and pedicle first approach for laparoscopic concomitant cholecystectomy and splenectomy in children. J Indian Assoc Pediatr Surg 2010; 15:93-5. [PMID: 21124663 PMCID: PMC2980930 DOI: 10.4103/0971-9261.71750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim: Laparoscopy is becoming the preferred modality for concomitant cholecystectomy and splenectomy (CAS). Usually, six to seven ports are employed for CAS, and spleen is removed by classical lateral approach or anterior approach. We report here our modified five-port and pedicle first approach for CAS in children to minimize the intraoperative bleeding and maximize the access. Materials and Methods: Twenty-one children underwent laparoscopic CAS with this new approach and their data were recorded prospectively. Following cholecystectomy (with ports 1–4), left side was elevated by 30°. The spleen was lifted by a grasper/fan retractor through port no. 5. The pedicle was dissected and splenic vessels were divided by ligasure (vessels < 8 mm), and for bulkier pedicle, vascular endo-GIA stapler was used. Short gastric and gastrosplenic ligament, lower pole and phrenico-colic attachments and upper pole attachments were dissected by ligasure in that sequence. Spleen was placed in endosac and delivered by digital fracture technique. Occasionally, lower transverse incision was made to deliver a massive spleen. Results: There were 12 males and 9 females with an average age of 8 years. Fourteen had sickle cell disease (SCD) and 7 had SCD and beta thalassemia. All CAS were completed successfully without any complication. Total duration was 160 minutes. Cholecystectomy took an average of 35 minutes. Average blood loss was 140 ml. The mean splenic weight was 900 g and mean length was 20 cm. Duration of hospitalization was 3–4 days. Conclusion: CAS can be successfully performed by five ports. The pedicle first approach is extremely helpful in moderate to massive spleens as it reduces splenic size, vascularity and bleeding from capsular adhesions or inadvertant lacerations.
Collapse
Affiliation(s)
- Kamalesh Pal
- Department of Surgery, King Fahad Hospital of the University, College of Medicine, University of Dammam, Al Khobar, Kingdom of Saudi Arabia
| |
Collapse
|
7
|
Attalla BI. Sonographic Findings in Sudanese Children With Sickle Cell Anemia. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2010. [DOI: 10.1177/8756479310386788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to evaluate the type and prevalence of abdominal sonographic abnormalities in children with sickle cell anemia (SCA). Ninety patients were screened by abdominal sonography. The sonographic abnormal findings were 91% in the liver, 62.2% in the spleen, 14.4% in the gallbladder, and 4.4% in the kidneys. Sonographic imaging revealed hepatomegaly in 79 (87.8%) patients. Three patients (3.3%) had hypoechoic liver lesions. One patient had multiple hypoechoic liver lesions that proved to be an abscess. Gallstones were reported in 10 patients, the youngest of whom was 2.5 years old. The overall prevalence of gallstones was 11.1%, and it increased with age. Two patients (2.2%) had thickened gallbladder wall, and only 1 patient (1.1%) had a sludged gallbladder. Autosplenectomy (asplenia) was detected in 43 (47.8%) patients. Seven (7.8%) patients had hypoechoic lesions. Hyperechoic lesions with spleenomegaly were found in 6 (6.6%) patients. Normal renal echogenecity was reported in 86 (95.6%) patients, 3 (3.3%) patients reported focal hyperechoic lesions, and 1 patient (1.1%) reported an anechoic lesion. In conclusion, abdominal sonographic imaging of patients with SCA revealed a high prevalence of abnormalities in the liver, gallbladder, and spleen but a low prevalence in the kidney.
Collapse
|
8
|
Marulanda GA, Minniti CP, Ulrich SD, Seyler TM, Mont MA. Perioperative management for orthopaedic patients with sickle cell anaemia. J Orthop Surg (Hong Kong) 2009; 17:346-50. [PMID: 20065378 DOI: 10.1177/230949900901700321] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To compare outcomes of 2 types of perioperative optimisation for patients with sickle cell anaemia (SCA) undergoing various orthopaedic surgeries. METHODS 12 female and 11 male patients aged 13 to 40 (mean, 18) years with SCA underwent 31 separate orthopaedic procedures for osteonecrosis of the femoral head. They were referred to a haematologist for 2 types of perioperative optimisation, based on the choice of the attending paediatrician. In the aggressive management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to 9 to 11 g/dl and to lower the haemoglobin S level to <30%. Fresh frozen plasma was given when their Factor VII level was <30%. In the conservative management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to a minimum of 10 g/dl. Fresh frozen plasma or packed red blood cells were given intra-operatively only when excessive bleeding occurred. The length of hospital stay, the number of perioperative complications, the number of transfusions, and episodes of alloimmunisation and/or vaso-occlusive crises in the two groups were compared. RESULTS No patient in the aggressive management group received supplemental oxygen or had an estimated intra-operative blood loss of >400 ml. Three patients in the conservative management group received multiple intra- and post-operative transfusions and supplemental oxygen. CONCLUSION Both aggressive and conservative protocols may be safely used in SCA patients. The more aggressive protocol resulted in lower rates for postoperative complications, transfusions, and resorting to supplemental oxygen.
Collapse
Affiliation(s)
- German A Marulanda
- Department of Orthopaedics and Sport Medicine, University of South Florida, Tampa, Florida, USA
| | | | | | | | | |
Collapse
|
9
|
Gumiero APDS, Bellomo-Brandão MA, Costa-Pinto EALD. Gallstones in children with sickle cell disease followed up at a Brazilian hematology center. ARQUIVOS DE GASTROENTEROLOGIA 2009; 45:313-8. [PMID: 19148360 DOI: 10.1590/s0004-28032008000400010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 04/09/2008] [Indexed: 01/11/2023]
Abstract
BACKGROUND Sickle cell disease causes chronic and recurrent hemolysis which is a recognized risk factor for cholelithiasis. This complication occurs in 50% of adults with sickle cell disease. Surgery is the consensual therapy for symptomatic patients, but the surgical approach is still controversial in asymptomatic individuals. AIMS To determine the frequency and to describe and discuss the outcome of children with sickle cell disease complicated with gallstones followed up at a tertiary pediatric hematology center. METHODS In a retrospective and descriptive study, 225 charts were reviewed and data regarding patient outcome were recorded. RESULTS The prevalence of cholelithiasis was 45% and half the patients were asymptomatic. The mean age at the time of diagnosis of cholelithiasis and surgical treatment was 12.5 years (standard deviation = 5) and 14 years (standard deviation = 5.4), respectively. The prevalence of cholelithiasis was higher in patients with SS homozygous and Sb heterozygous thalassemia when compared to patients with sickle cell disease. In 50% of symptomatic patients, recurrent abdominal pain was the single or predominant symptom. Thirty-nine of 44 patients submitted to surgery reported symptom relief after the surgical procedure. Asymptomatic individuals who did not undergo surgical treatment were followed up for 7 years (standard deviation = 4.8), and none of them presented complications related to cholelithiasis during this period. CONCLUSIONS The frequency of cholelithiasis in the study population was 45%. One-third of the patients were diagnosed before 10 years of age. Patients with the SS homozygous or Sb heterozygous phenotype were at a higher risk for the development of cholelithiasis than patients with sickle cell disease. About 50% of patients with gallstones were asymptomatic, the most of them did not undergo surgery and did not present complications during a 7-year follow-up period. Cholecystectomy must be considered in symptomatic patients. In asymptomatic patients, conservative management seems to be the better choice.
Collapse
|
10
|
van Geffen C, Savary-Bataille K, Chiers K, Giger U, Daminet S. Bilirubin cholelithiasis and haemosiderosis in an anaemic pyruvate kinase-deficient Somali cat. J Small Anim Pract 2008; 49:479-82. [PMID: 18684151 DOI: 10.1111/j.1748-5827.2008.00568.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A Somali cat was presented with recurrent anorexia, lethargy, vomiting and icterus. A macrocytic-hypochromic, regenerative haemolytic anaemia was identified and hereditary pyruvate kinase deficiency was confirmed by means of breed-specific DNA mutation analysis. The case was complicated by the presence of markedly elevated serum liver enzyme activities, hyperbilirubinaemia, coagulopathy and ultrasonographic evidence of gall bladder choleliths and extrahepatic bile duct obstruction. The choleliths consisted of 100 per cent bilirubin, likely because of chronic haemolysis and haeme degradation. In conclusion, haemosiderosis and bilirubin cholelithiasis can be a consequence of chronic haemolysis in pyruvate kinase-deficient cats, as seen in human beings with a variety of chronic haemolytic disorders.
Collapse
Affiliation(s)
- C van Geffen
- Department of Medicine and Clinical Biology of Small Animals, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium
| | | | | | | | | |
Collapse
|
11
|
Gumiero APS, Brandão MÂB, Pinto EALC, Anjos ACD. Colelitíase no paciente pediátrico portador de doença falciforme. REVISTA PAULISTA DE PEDIATRIA 2007. [DOI: 10.1590/s0103-05822007000400014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Considerando a alta freqüência da colelitíase no paciente pediátrico com doença falciforme e a controvérsia na literatura sobre a abordagem da condição, o presente texto objetiva revisar a literatura disponível. FONTE DE DADOS: Revisão dos estudos sobre colelitíase no paciente falciforme, publicados no período entre 1980 e 2007, em língua inglesa e portuguesa, envolvendo pacientes na faixa etária de zero a 18 anos e utilizando os bancos de dados Medline e Lilacs. SÍNTESE DOS DADOS: A colelitíase é a complicação digestiva mais comum no paciente falciforme e sua incidência aumenta com a faixa etária. Os mecanismos fisiopatológicos são conhecidos, assim como os métodos diagnósticos. A conduta terapêutica consensual na colelitíase sintomática é a colecistectomia, preferencialmente por via laparoscópica. Nos casos assintomáticos, a maioria dos autores recomenda a conduta cirúrgica, para evitar complicações, confusão no diagnóstico diferencial de dor abdominal futura e menor risco cirúrgico. Contudo, não existe consenso na literatura, havendo base para a adoção de conduta expectante. CONCLUSÕES: A doença falciforme tem grandes variações em sua apresentação clinica, história natural e gravidade da hemólise. Algumas populações podem apresentar menor freqüência de colelitíase e menor número de pacientes sintomáticos, possivelmente em razão de variações de haplótipos, fatores ambientais e diferentes manejos clínicos. Ainda não existem dados suficientes na literatura ou estudos randomizados e controlados que possibilitem definir o momento ideal para a colecistectomia no paciente falciforme com litíase assintomática. Dessa maneira, dependendo de características individuais e da população, podem ser aceitos o seguimento clínico ou a indicação precoce de colecistectomia.
Collapse
|
12
|
Patkowski D, Chrzan R, Wróbel G, Sokół A, Dobaczewski G, Apoznański W, Zaleska-Dorobisz U, Czernik J. Laparoscopic Splenectomy in Children: Experience in a Single Institution. J Laparoendosc Adv Surg Tech A 2007; 17:230-4. [PMID: 17484655 DOI: 10.1089/lap.2006.0058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To assess the safety and effectiveness of laparoscopic splenectomy in children. MATERIALS AND METHODS Hospital records of 63 patients who underwent laparoscopic splenectomy between 1998 and 2005 were reviewed retrospectively. In 16 patients concomitant cholecystectomy was performed. All procedures were performed by the same surgeon. The indications for splenectomy were hereditary spherocytosis (n = 35), idiopathic thrombocytopenic purpura (n = 22), autoimmune hemolytic anemia (n = 3), and other diseases (n = 3). Details of operative technique were reviewed and their implications on intraoperative complications are analyzed. The postoperative course and long-term results were assessed. RESULTS There were 35 girls and 28 boys, whose average age was 11.3 years (range, 3.9-19.5 years). There were 7 conversions, mainly at the beginning of the series. A mild degree of intraoperative bleeding was observed in 23 (36.5%) cases. In two cases (3%) severe bleeding led to conversion. Postoperatively, 1 patient required blood transfusion and 1 patient had signs of mild general infection that was treated conservatively. There was no mortality in this series. The mean operation time was 134 minutes for splenectomy and 174 minutes for splenectomy and cholecystectomy. Operative time did not significantly diminish at the end of the 7-year study period. CONCLUSION Laparoscopic splenectomy in children performed by an experienced team proved to be safe and effective with minimal side effects and should be recommended as a procedure of choice in children who require splenectomy.
Collapse
Affiliation(s)
- Dariusz Patkowski
- Department of Paediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Holterman AXL, Adams KN, Seeler RA. Surgical Management of Pediatric Hematologic Disorders. Surg Clin North Am 2006; 86:427-39, x. [PMID: 16580932 DOI: 10.1016/j.suc.2005.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Ai-Xuan L Holterman
- Department of Surgery, Division of Pediatric Surgery, University of Illinois at Chicago, 840 South Wood Street, M/C 958 Chicago, IL 60612, USA.
| | | | | |
Collapse
|