Elective cholecystectomy reduces morbidity of cholelithiasis in pediatric sickle cell disease

• Published in: Pediatric blood & cancer Vol. 64; no. 1; pp. 113 - 120
• Main Authors: Goodwin, Emily F., Partain, Paige I., Lebensburger, Jeffrey D., Fineberg, Naomi S., Howard, Thomas H.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.01.2017
• Subjects: Anemia, Sickle Cell - complications; Child; Child, Preschool; Cholecystectomy; Cholecystectomy - methods; Cholelithiasis - etiology; Cholelithiasis - surgery; Elective Surgical Procedures - methods; Female; Follow-Up Studies; Hematology; Humans; Length of Stay - statistics & numerical data; Male; Morbidity; Oncology; pediatric hematology/oncology; Pediatrics; Prognosis; Retrospective Studies; sickle cell anemia; Sickle cell disease; surgery; Ultrasonic imaging; pediatric hematology/oncology; sickle cell anemia; surgery
• ISSN: 1545-5009; 1545-5017
• DOI: 10.1002/pbc.26179

Background Cholelithiasis is a frequent complication in pediatric sickle cell disease (SCD). Though it is standard practice to perform a cholecystectomy in pediatric SCD patients with symptoms of cholelithiasis, the use of elective cholecystectomy for asymptomatic patients remains controversial. Procedure Records of 191 pediatric sickle cell patients with cholelithiasis who underwent cholecystectomy were retrospectively reviewed. Patients classified as follows: (i) elective—no preoperative symptoms, cholelithiasis on screening ultrasound, comprehensive preoperative plan; (ii) symptomatic—preoperative symptoms of cholelithiasis on diagnostic ultrasound, comprehensive preoperative plan; or (iii) emergent—hospitalization for acute cholecystitis symptoms, cholelithiasis on diagnostic ultrasound, limited preoperative preparation. We compared the morbidity of cholecystectomy by examining pre‐ and post‐cholecystectomy hospital admission days, length of stay for cholecystectomy, and surgical complications. Results Patients with SCD underwent a total of 191 cholecystectomies over a 10‐year period: 51 elective, 110 symptomatic, and 30 emergent. Patients who required emergent cholecystectomy had a longer postoperative hospitalization time than elective or symptomatic cholecystectomy (7.3 vs 4.3, P < 0.001). Baseline values for total bilirubin and aspartate aminotransferase (AST) were significantly elevated (P < 0.02 and P < 0.07, respectively) in patients requiring emergent cholecystectomy. Conclusions This represents the largest reported retrospective review of pediatric cholelithiasis and cholecystectomy in SCD to date. These data strongly suggest that elective cholecystectomy decreases morbidity associated with emergent cholecystectomy. The overall outcomes for symptomatic and elective patients are favorable. However, our study indicates the need for prospective studies to identify clinical indicators for those emergent patients.