A case series of cholecystectomy in Jamaican sickle cell disease patients - The need for a new strategy

- 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.

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.