8- LAPAROSCOPIC CHOLECYSTECTOMY IN SICKLE CELL DISEASE: IS IT A SAFE PROCEDURE?

The aim of this trial is to determine the safety of laparoscopic cholecystectomy for treatment of gall bladder stones in patients with sickle cell anemia (a controversial issue). Sixty patients from both sexes, between 19-35 years old with sickle cell anemia, all of them having gall bladder stones were included in this study in Endosurgery Center in Basrah General Hospital. The patients were divided into three groups, group one (19 patients) were selected for laparoscopic cholecystectomy on random preoperative background, the same thing was applied in group two (21 patients) whose patients were subjected to open cholecystectomy while patients in group three (20 patients) were selected for laparoscopic cholecystectomy on conditioned selection. Three mortalities and two serious morbidities were encountered in the group one and one mild morbidity seen in group two and no mortalities or morbidities in group three. Laparoscopic cholecystectomy in sickle cell patients is a debatable issue, an increasing controversy about serious perioperative and postoperative morbidity were mentioned. The procedure itself was accused and an entirely opposed results were emerged from different studies all are debatable. In this study we noticed the big influence of the risk factors, preparation of patients for surgery and the adherence to the principle anesthetic rules on the outcome after laparoscopic cholecystectomy in patients with sickle cell disease. This influence was limited in open procedure. The controversy in the different trials lies on wither the problem is confined to the disease itself or to the surgical method used for cholecystectomy or both. According to the results obtained from our study we believe that both the severity of the disease and the surgical procedure affecting the results, application of intra and post operative protocol (blood transfusion if Hb less than 9gm/dI, rehydration, oxygenation and respecting general anesthesia rules are mandatory for the safety of the patients.