Place for elective cholecystectomy for patients with severe thalassaemia: a retrospective case control study

Abstract

Objective At present, cholecystectomy is carried out for thalassaemia patients with gall stone disease only if they develop symptoms of cholecystitis, except in the rare instance where an un-inflammed gall bladder is removed simultaneously with splenectomy. We carried out this retrospective analysis of case records to examine if patients with thalassaemia have a higher rate of peri operative complications compared to non-thalassaemics with gall stone disease, warranting a change of policy to justify elective cholecystectomy. Results Case records of 540 patients with thalassaemia were retrospectively analysed of which 98 were found to have gallstones. Records of 62 patients without thalassaemia with gall stone disease too were used for comparison. 19 of patients with thalassaemia and 52 of non-thalassaemic who had gallstones had undergone cholecystectomy. In all but 5 patients with thalassaemia cholecystectomy was done following attacks of acute cholecystitis as was the case in the non-thalassaemic controls. A significantly higher proportion of early and late complications had occurred in thalassaemia patients compared to non-thalassaemic patients post operatively. Six deaths related to sepsis following acute cholecystitis in the peri operative period were reported among 19 thalassaemia patients whereas no deaths were reported among 55 non-thalassaemic patients who underwent cholecystectomy for gallstones.

Cholelithiasis Diagnosis and Management in Thalassemia

“…4 Children with thalassemia have a 10 -20% higher risk of cholelithiasis compared to the general population, often remains asymptomatic for many years. 2 This was the a. b.…”

“…However, it often remains asymptomatic for many years. 2 Management for non-thalassemic patients with cholelithiasis is usually conservative unless signs of cholecystitis or cholangitis were found. However, due to the increased risk of complications, a tailored approach is required for managing cholelithiasis in thalassemia patients.…”

“…However, due to the increased risk of complications, a tailored approach is required for managing cholelithiasis in thalassemia patients. 2 This case report illustrated the manifestations of cholelithiasis presenting in a thalassemic child, with the aim to increase the recognition of cholestasis signs and symptoms in children.…”

Management of childhood cholelithiasis: experience at a third-level pediatric surgical center

“…Liu and colleagues found that surgical interventions for asymptomatic gallstones in patients with hereditary spherocytosis necessitating splenectomy were linked to a reduced risk of adverse outcomes 9 . Premawardhena et al strongly advocated that elective LC should be considered in patients with thalassemia to prevent the onset of serious complications associated with LC in symptomatic patients 10 .…”