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Surgical Endoscopy

, Volume 32, Issue 5, pp 2300–2311 | Cite as

Low-impact laparoscopic cholecystectomy is associated with decreased postoperative morbidity in patients with sickle cell disease

  • Nicola de’Angelis
  • Solafah Abdalla
  • Maria Clotilde Carra
  • Vincenzo Lizzi
  • Aleix Martínez-Pérez
  • Anoosha Habibi
  • Pablo Bartolucci
  • Frédéric Galactéros
  • Alexis Laurent
  • Francesco Brunetti
Article

Abstract

Background

Laparoscopic cholecystectomy (LC) is one of the most frequent surgeries performed in patients with sickle cell disease (SCD). LC in SCD patients is associated with a particularly high postoperative morbidity. The aim of the present study is to assess the safety and feasibility of cholecystectomy performed by mini-laparoscopy with low- and stable-pressure pneumoperitoneum (MLC + LSPP) and to compare the rate of postoperative SCD-related morbidity with standard LC.

Methods

Thirty-five consecutive SCD patients admitted between November 2015 and March 2017 for cholelithiasis requiring surgery were compared with an historical cohort of 126 SCD patients who underwent LC for the same indication. Operative variables, postoperative outcomes, patient and surgeon satisfaction, and costs were evaluated.

Results

MLC + LSPP exhibited a mean operative time comparable to LC (p = 0.169). Operative blood loss was significantly reduced in the MLC + LSPP group, and the suction device was rarely used (p = 0.036). SCD-related morbidity (including acute chest syndrome) was significantly higher in the LC group compared with the MLC + LSPP group (18.3 vs. 2.9%; p = 0.029). The mean times to resume ambulation (p = 0.018) and regular diet (p = 0.045) were significantly reduced in the MLC + LSPP group. The mean incision length (all trocars combined) was 28.22 mm for MLC + LSPP and 49.64 mm for LC patients (p < 0.0001). Multivariate regression analysis demonstrated that the only significant predictor of postoperative SCD-related morbidity was the surgical approach (odds ratio: 9.24). Patient and surgeon satisfaction were very high for MLC + LSPP. The mean total cost per patient (surgery and hospitalization) was not different between groups (p = 0.084).

Conclusion

MLC + LSPP in SCD patients appears to be safe and feasible. Compared with LC, MLC + LSPP in SCD patients is associated with a significantly reduced incidence of postoperative SCD-related morbidity and more rapid ambulation and return to regular diet without increasing the total costs per patient.

Keywords

Sickle cell disease Micro-laparoscopy Low-pressure pneumoperitoneum Low-impact laparoscopy Cholecystectomy 

Notes

Compliance with ethical standards

Disclosure

Nicola de’Angelis, Solafah Abdalla, Maria Clotilde Carra, Vincenzo Lizzi, Aleix Martínez-Pérez, Anoosha Habibi, Pablo Bartolucci, Frédéric Galactéros, Alexis Laurent, and Francesco Brunetti have no conflicts of interest to disclose with regard to the results of this study.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Nicola de’Angelis
    • 1
  • Solafah Abdalla
    • 1
  • Maria Clotilde Carra
    • 2
  • Vincenzo Lizzi
    • 1
  • Aleix Martínez-Pérez
    • 1
  • Anoosha Habibi
    • 3
    • 4
  • Pablo Bartolucci
    • 3
    • 4
  • Frédéric Galactéros
    • 3
    • 4
  • Alexis Laurent
    • 1
    • 4
  • Francesco Brunetti
    • 1
  1. 1.Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri-Mondor Hospital, AP-HPUniversité Paris Est – UPECCréteilFrance
  2. 2.Rothschild Hospital, AP-HPUniversity of Paris DiderotParisFrance
  3. 3.Department of Internal Medicine, Sickle Cell Referral Center, AP-HPHenri Mondor University HospitalCréteilFrance
  4. 4.UPEC, Institut Mondor de Recherche Biomédicale (IMRB)Institut National de la Santé et de le Recherche Médicale (INSERM) U955CréteilFrance

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