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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.
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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)
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Albakri LA, Algarni RA, Alrajhi RK, Yousef YA, Zaidi SF. Laparoscopic Cholecystectomy Operative Time and Hospital Stay Differences Between Sicklers and Non-sicklers: A Five-Year Comparative Cross-Sectional Study at King Abdulaziz Medical City, Jeddah. Cureus 2022; 14:e30952. [PMID: 36465760 PMCID: PMC9713063 DOI: 10.7759/cureus.30952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 06/17/2023] Open
Abstract
Background Sickle cell disease (SCD) is one of the most important hemoglobinopathies that result in the formation of pigment gallstones. Laparoscopic cholecystectomy (LC) is a safe surgical procedure for gallstones in SCD. Currently, there is no standard or guidelines for the preoperative preparation of these patients. This study aims to estimate the difference in pre-operative length of stay, operative time, postoperative length of stay, and total hospitalization length of stay among patients with and without SCD in a tertiary hospital in Jeddah, Saudi Arabia. Such knowledge would aid in establishing a standard for the preoperative preparation of SCD patients for LC. Methods Data from all patients undergoing laparoscopic cholecystectomy between January 2013 and December 2018 were collected retrospectively with a comparative cross-sectional study design. Data included age, sex, BMI, clinical presentation, mode of admission (elective or emergency), preoperative length of stay, operative time, postoperative length of stay, total hospitalization length of stay, and type of surgery (day or inpatient). JMP 15.2.1 was used for statistical analysis. Results From 2013 to 2018, 793 patients underwent LC, and of those, 16 (2.018%) were SCD patients. The results showed significant differences in preoperative (p<0.001), postoperative (p<0.001), and total hospitalization stay time (p<0.001) between the SCD patients and non-SCD patients. However, the data show no significant difference in the operative time of LC between the two studied groups. Conclusion SCD is the most common hemoglobinopathy-causing gallstone. Challenges in these patients are mainly in peri-operative management. Further prospective cohort studies are needed to create a standardized approach for peri-operative management of SCD patients to facilitate delivery of the same level of care and shorten total hospitalization time.
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Affiliation(s)
- Lamair A Albakri
- Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Reem A Algarni
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Rawan K Alrajhi
- College of Medicine, King Saud Bin Abdulaziz University of Health Sciences, Jeddah, SAU
| | - Yasmin A Yousef
- Department of Surgery, Pediatric Surgery Section, King Abdulaziz Medical City, Jeddah, SAU
| | - Syed Faisal Zaidi
- Faculty of Eastern Medicine, Hamdard University, Islamabad Capital Territory, PAK
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Rambaud E, Ranque B, Pouchot J, Arlet JB. Complications lithiasiques chez les patients drépanocytaires. Rev Med Interne 2022; 43:479-486. [DOI: 10.1016/j.revmed.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
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Alzahrani F, Fallatah AM, Al-Haddad FM, Khayyat ST, AlMehmadi WM, AlQahtani BG, Alamri RS. Risk Factors and Complications Among Pediatric Patients With Sickle Cell Anemia: A Single Tertiary Center Retrospective Study. Cureus 2021; 13:e12440. [PMID: 33552759 PMCID: PMC7851883 DOI: 10.7759/cureus.12440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objective Sickle cell anemia (SCA) is one of the common genetic diseases in the Kingdom of Saudi Arabia (KSA). This disease results from a genetic mutation that causes malformation of the red blood cells (RBCs), leading to various systemic complications, including vaso-occlusive crisis (VOC), acute chest syndrome (ACS), osteomyelitis, avascular necrosis (AVN), and stroke, to name a few. The leading cause of mortality in SCA is these systemic complications rather than the disease itself. Understanding the risk factors of these complications can help reduce mortality in these patients and improve their quality of life. In this study, we aimed to determine the risk factors of SCA complications among pediatric patients with SCA at King Abdulaziz University Hospital (KAUH) in Jeddah, KSA. Methods This retrospective study was carried out from January 2012 till June end 2019. It was conducted among pediatric patients with SCA. Patients were screened for eligibility, and we excluded those with thalassemia and those who had a medical history of chronic diseases. Data were collected from patients' electronic medical records. Results The study included 102 pediatric patients with SCA; their mean age was 7.88 ±4.22 years; almost half of them were females (56%) and 44% were males. The dominant body mass index (BMI) classification among them was normal (49%). Urinary tract infection (UTI) was the most common complication with 38 cases followed by VOC with 32 cases. Other complications observed were ACS (25.5%) followed by stroke (15.7%). HbSS was the most prominent genotype among these patients, and it was associated with a higher rate of complications. However, there was no significant relationship between genotype and patients developing complications. Finally, patients with high white blood cell (WBC) counts, elevated systolic blood pressure (SBP), and hypoxia developed more complications, and there was a significant relationship between these conditions and the development of complications (p<0.05). Conclusion Based on our findings, patients with high WBC count, elevated SBP, and hypoxia are at greater risk of developing complications. Accordingly, healthcare providers should consider putting in place all measures required to provide a good quality of life for these patients, including raising awareness about the risk factors that lead to these complications, appropriate immunizations, and precautionary measures to promote these patients' welfare.
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Affiliation(s)
| | - Anas M Fallatah
- Medicine, College of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Fatimah M Al-Haddad
- Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Shahad T Khayyat
- Medicine, College of Medicine, King Abdulaziz University, Jeddah, SAU
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Cawich SO, Dapri G, Fa Si Oen P, Thomas D, Naraynsingh V. Single Incision Laparoscopic Surgery: Feasibility of the Direct Fascial Puncture Technique Without Working Trocars. Cureus 2020; 12:e10742. [PMID: 33145144 PMCID: PMC7599059 DOI: 10.7759/cureus.10742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction As single-incision laparoscopic surgery (SILS) became popular, many access platforms and techniques emerged. When we initially described the direct fascial puncture (DFP) technique, many suggested it was not practical for three reasons: (1) increased hernia formation, (2) inability to complete operations without instrument changes and (3) insurmountable instrument drag. This study sought to determine whether the technique was a feasible approach by evaluating the outcomes with DFP-SILS in a single surgeon unit. Methods This was a retrospective audit of all consecutive patients who had unselected SILS operations by a single surgeon. For the DFP-SILS operation, a single optical trocar was used at the umbilicus, a second was rail-roaded beside the optical trocar and a third was directly passed across the fascia at the left-lateral extent of the skin wound. We recorded the number of conversions or failed operations and examined the patients routinely after operation to evaluate for incisional herniae. Results There were 50 DFP-SILS operations performed: 37 cholecystectomies, 12 appendectomies and one jejunal resection. The operations were successful in all cases with no conversions or mortality recorded. One patient (2%) developed a superficial surgical site infection after SILS-DFP appendectomy. The therapeutic outcomes were comparable to existing series of multi-port laparoscopy. There were no incisional herniae detected. Conclusion Even in the resource-poor setting, SILS operations are feasible and safe using the DFP technique. The theoretic concerns have not been realized in clinical practice.
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Affiliation(s)
| | - Giovanni Dapri
- Surgery, International School of Reduced Scar Laparoscopy, Brussels, BEL
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de’Angelis N, Abdalla S, Carra MC, Lizzi V, Martínez-Pérez A, Habibi A, Bartolucci P, Galactéros F, Laurent A, Brunetti F. Low-impact laparoscopic cholecystectomy is associated with decreased postoperative morbidity in patients with sickle cell disease. Surg Endosc 2017; 32:2300-2311. [PMID: 29098436 DOI: 10.1007/s00464-017-5925-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/08/2017] [Indexed: 01/05/2023]
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Al Talhi Y, Shirah BH, Altowairqi M, Yousef Y. Laparoscopic cholecystectomy for cholelithiasis in children with sickle cell disease. Clin J Gastroenterol 2017; 10:320-326. [PMID: 28555355 DOI: 10.1007/s12328-017-0750-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/14/2017] [Indexed: 12/13/2022]
Abstract
Patients with sickle cell disease (SCD) suffer from an increased incidence of gallstone formation due to hemolysis of sickled red blood cells; this leads to an increased level of bilirubin in secreted bile that becomes a nidus for pigment stone formation. Laparoscopic cholecystectomy (LC) is considered a standard operative procedure for gallstone disease mainly due to lower postoperative wound complaints, faster recovery, better postoperative cosmetic results, shorter hospital stay, and earlier return to work. Although numerous studies have been published addressing both the advantages and complications of LC in acute calcular cholecystitis, there is still limited evidence concerning the safety and efficacy of LC for the management of cholelithiasis in pediatric patients with SCD, and controversies remain unresolved. In this review, we aim to comprehensively study the available literature and propose evidence-based practice recommendations for the optimal management of gallstones in pediatric SCD patients. The current practice differs greatly depending on the prevalence of SCD in a particular geographic area. We acknowledge the limited number of patients reported, the lack of randomized control trials addressing the practice of specific recommendations, and the need for further evidence-based studies.
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Affiliation(s)
- Yousef Al Talhi
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Sciences, P.O. Box: 65362, Jeddah, 21556, Saudi Arabia
| | - Bader Hamza Shirah
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Sciences, P.O. Box: 65362, Jeddah, 21556, Saudi Arabia.
| | | | - Yasmin Yousef
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Sciences, P.O. Box: 65362, Jeddah, 21556, Saudi Arabia.,King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Leake PA, Reid M, Plummer J. A case series of cholecystectomy in Jamaican sickle cell disease patients - The need for a new strategy. Ann Med Surg (Lond) 2017; 15:37-42. [PMID: 28228943 PMCID: PMC5312456 DOI: 10.1016/j.amsu.2017.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 01/05/2023] Open
Abstract
High morbidity rates related to cholecystectomy in sickle cell disease (SCD) patients have been previously reported in the region. This study serves to assess the current outcomes related to cholecystectomy in a Jamaican SCD population. METHODS: A retrospective chart review of SCD patients undergoing elective cholecystectomy at the University Hospital of the West Indies over a 6-year period was performed providing relevant information for analysis. Patients were grouped on an intention-to-treat basis into an open and laparoscopic group. RESULTS: A total of 27 patients were included (18 laparoscopic and 9 open). Both groups were matched for age, gender and steady state hemoglobin. Only one patient (in the open group) received preoperative blood transfusion. The conversion rate for laparoscopy was 28%. Operative time was significantly longer in the open group (175.3 ± 62.1 vs. 125.9 ± 54.4 min, p = 0.0355). Bile duct exploration was undertaken in 66.7% of patients in the open group compared to 0% in the laparoscopic group. There was no significant difference between groups with respect to hospital stay, morbidity or mortality. The overall 30-day morbidity was 48.1% with acute chest syndrome being diagnosed in 6 patients and pneumonia in 7 patients. CONCLUSION: Morbidity rates related to cholecystectomy in the Jamaican SCD population remain high. Further studies to evaluate the factors contributing to such high morbidity in this population are warranted, with particular focus on laparoscopic cholecystectomy. Strategies such as preoperative transfusion and prophylactic cholecystectomy also need to be evaluated and considered in this patient group. Morbidity rates for cholecystectomy in Jamaican sickle cell patients remain high. There is a trend to higher morbidity for laparoscopic over open cholecystectomy. Preoperative transfusion is rarely employed in this patient population.
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Affiliation(s)
- Pierre-Anthony Leake
- Department of Surgery, Radiology, Anaesthetics & Intensive Care, University of the West Indies, Mona Campus, Jamaica
| | - Marvin Reid
- Tropical Metabolic Research Institute, University of the West Indies, Mona Campus, Jamaica
| | - Joseph Plummer
- Department of Surgery, Radiology, Anaesthetics & Intensive Care, University of the West Indies, Mona Campus, Jamaica
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Martins RA, Soares RS, Vito FBD, Barbosa VDF, Silva SS, Moraes-Souza H, Martins PRJ. Cholelithiasis and its complications in sickle cell disease in a university hospital. Rev Bras Hematol Hemoter 2017; 39:28-31. [PMID: 28270342 PMCID: PMC5339364 DOI: 10.1016/j.bjhh.2016.09.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/02/2016] [Accepted: 09/09/2016] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The clinical manifestations of sickle cell disease are related to the polymerization of hemoglobin S. The chronic hemolysis caused by this condition often causes the formation of gallstones that can migrate and block the common bile duct leading to acute abdomen. OBJECTIVE This study aimed to evaluate the profile of patients with sickle cell disease and cholelithiasis. METHODS Patients with sickle cell disease were separated into groups according to the presence or absence of cholelithiasis. Socioepidemiological and clinical characteristics, such as gender, age, use of hydroxyurea and the presence of other hemoglobinopathies were researched in the medical records of patients. RESULTS A hundred and seven patients with sickle cell anemia were treated at the institution. Of these, 27 (25.2%) had cholelithiasis. The presence of cholelithiasis was higher in the 11-29 age group than in younger than 11 years and over 29 years. No association was found for the presence of cholelithiasis with gender, use of hydroxyurea or type of hemoglobinopathy (hemoglobin SS, hemoglobin SC or sickle beta-thalassemia). Sixteen of the patients had to be submitted to cholecystectomy with 14 of the surgeries being performed by laparoscopy. Complications were observed in three patients and one patient died for reasons unrelated to the surgery. CONCLUSION A quarter of patients with sickle cell disease had gallstones, more commonly in the 11- to 29-year age range. Patients should be monitored from childhood to prevent cholelithiasis with preoperative, intra-operative and postoperative care being crucial to reduce the risk of complications in these patients.
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Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, Lombari P, Narilli P, Marchi D, Carrara A, Esposito MG, Fiume S, Miranda G, Barlera S, Davoli M. Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbecks Arch Surg 2015; 400:429-53. [PMID: 25850631 DOI: 10.1007/s00423-015-1300-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/24/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the gold standard technique for gallbladder diseases in both acute and elective surgery. Nevertheless, reports from national surveys still seem to represent some doubts regarding its diffusion. There is neither a wide consensus on its indications nor on its possible related morbidity. On the other hand, more than 25 years have passed since the introduction of LC, and we have all witnessed the exponential growth of knowledge, skill and technology that has followed it. In 1995, the EAES published its consensus statement on laparoscopic cholecystectomy in which seven main questions were answered, according to the available evidence. During the following 20 years, there have been several additional guidelines on LC, mainly focused on some particular aspect, such as emergency or concomitant biliary tract surgery. METHODS In 2012, several Italian surgical societies decided to revisit the clinical recommendations for the role of laparoscopy in the treatment of gallbladder diseases in adults, to update and supplement the existing guidelines with recommendations that reflect what is known and what constitutes good practice concerning LC.
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Affiliation(s)
- Ferdinando Agresta
- Department of Surgery, Presidio Ospedaliero di Adria (RO), Adria, RO, Italy,
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Cawich SO, Arthurs M, Murphy T, Bonadie KO, Roberts HA, Naraynsingh V. Complications of ERCP for choledocholithiasis in a sickle cell cohort. Trop Doct 2014; 45:15-20. [PMID: 25315239 DOI: 10.1177/0049475514552550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Patients with sickle cell disease (SCD) demand special attention during clinical interventions because they are predisposed to acute chest syndrome (ACS), vaso-occlusive crises, intra-vascular haemolysis and immune paresis. Although SCD is endemic in the Caribbean, there has been no report on endoscopic retrograde cholangio-pancreatography (ERCP) outcomes in these patients from this region. Study The records of patients with SCD who underwent ERCP between 1 January 2005 and 1 June 2010 were analysed retrospectively. Parameters assessed included patient demographics, procedural details, ERCP-related and SCD-related morbidity. Data were analysed using SPSS version 12.0. Results Fifty-four patients with SCD were subjected to ERCP during the study period. There were 37 women and 17 men at a mean age of 28 years (SD +/−12.05). There was 29% (16) overall morbidity, with 10 (18.5%) SCD-related complications and six (11.1%) ERCP-specific complications. More common complications were: pancreatitis (9.3%); cholangitis (1.9%); ACS (9.3%); pneumonia (3.7%); and painful crises (5.6%). There was one death (1.9%) due to multiple organ failure secondary to severe pancreatitis. Conclusions This study suggests that the SCD cohort requires special perioperative attention to minimise the inordinately high morbidity, many of which are SCD-related. We propose a perioperative management protocol that may minimise morbidity in these patients.
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Affiliation(s)
- Shamir O Cawich
- Hepatopancreatobiliary Surgeon, Department of Clinical Surgical Sciences, University of the West Indies, Trinidad & Tobago
| | - Milton Arthurs
- Gastroenterologist, Faculty of Medicine, University of the West Indies, Kingston 7, Jamaica
| | - Trevor Murphy
- Gastroenterologist, Faculty of Medicine, University of the West Indies, Kingston 7, Jamaica
| | - Kimon O Bonadie
- Hepatopancreatobiliary Surgeon, Department of Clinical Surgical Sciences, University of the West Indies, Trinidad & Tobago
| | - Hugh A Roberts
- General Surgeon, Faculty of Medicine, University of the West Indies, Kingston 7, Jamaica
| | - Vijay Naraynsingh
- Professor of Surgery, Department of Clinical Surgical Sciences, University of the West Indies, Trinidad & Tobago
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Papafragkakis H, Ona MA, Changela K, Sadanandan S, Jelin A, Anand S, Duddempudi S. Acute liver function decompensation in a patient with sickle cell disease managed with exchange transfusion and endoscopic retrograde cholangiography. Therap Adv Gastroenterol 2014; 7:217-23. [PMID: 25177368 PMCID: PMC4107698 DOI: 10.1177/1756283x14530781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Sickle cell intrahepatic cholestasis is a relatively uncommon complication of homozygous sickle cell anemia, which may lead to acute hepatic failure and death. Treatment is mainly supportive, but exchange transfusion is used as salvage therapy in life threatening situations. We describe a case of a 16-year-old female with homozygous sickle cell anemia who presented to the emergency room with fatigue, malaise, dark urine, lower back pain, scleral icterus and jaundice. She was found to have marked hyperbilirubinemia, which persisted after exchange transfusion. Because of the concomitant presence of gallstones and choledocholithiasis, the patient underwent endoscopic ultrasound and laparoscopic cholecystectomy followed by endoscopic retrograde cholangiography and sphincterotomy.
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Affiliation(s)
- Haris Papafragkakis
- Department of Gastroenterology, The Brooklyn Hospital Center, 121 DeKalb Ave, Brooklyn, NY 11201, USA
| | - Mel A. Ona
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Kinesh Changela
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Swayamprabha Sadanandan
- Department of Pediatric Hematology/Oncology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Abraham Jelin
- Department of Pediatric Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sury Anand
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sushil Duddempudi
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
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Cawich SO, Mohanty SK, Simpson LK, Bonadie KO. Is emergent laparoscopic cholecystectomy for acute cholecystitis safe in a low volume resource poor setting? Int J Surg 2014; 12:798-802. [PMID: 24947946 DOI: 10.1016/j.ijsu.2014.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/01/2014] [Accepted: 06/05/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The outcomes of emergent laparoscopic cholecystectomy (LC) for acute cholecystitis have not been documented in the low-volume, resource-poor Caribbean setting. SETTINGS AND DESIGN This study was carried out in a low-resource setting across three islands in the Anglophone Caribbean. METHODS AND MATERIALS The records of all consecutive patients who had emergency LC for acute cholecystitis over 82 months were examined. The data were extracted and analysed using SPSS version 14. RESULTS There were 74 patients with acute cholecystitis at a mean age of 45 (SD 11.8) years. The mean duration of operation was 99 (SD 45) min. There were 3 (4.1%) conversions and 6 (8.1%) complications. No bile duct injuries or deaths were recorded. There was more morbidity in patients with complicated disease, longer mean operation times and longer mean intervals between admission and operation. CONCLUSIONS Emergent LC for acute cholecystitis is effective and safe in a low-volume setting in the Caribbean. However, the operations are technically demanding and should be performed by trained laparoscopic surgeons.
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Affiliation(s)
- Shamir O Cawich
- The Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago.
| | - Sanjib K Mohanty
- The Department of Surgery, Cayman Islands Hospital, Grand Cayman, British West Indies, Cayman Islands
| | | | - Kimon O Bonadie
- Department of Surgery, McGill University Hospital, Montreal, Quebec, Canada
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