Cholecystectomy in sickle-cell disease: the Jamaican experience

ABSTRACT

Fifty-eight patients with homozygous sickle-cell disease had cholecystectomy for symptomatic gallstones between January 1986 and September 1995 at the University Hospital of the West Indies and the Bustamante Hospital for Children, Jamaica. Top-up blood transfusion was administered to 7 patients with haemoglobin levels > lgm/dl below their steady state values. Complications related to the presence of biliary calculi were cholecystitis (58), common bile duct (CBD) dilatation (20), gallbladder empyema (2), and gallstone ileus (1). Nine developed the acute chest syndrome post-operatively leading to death in two patients. Three had retained CBD stones, which passed into the duodenum after a trial of saline irrigation via an in-situ t-tube. Because pre-operative ultrasonography is an unrelialbe modality for detecting CBD stones and also because of the high presence of CBD stones in sickle-cell disease, routine operative cholangiography is recommended at the time of surgery (AU)