β Thalassemia patients suffer from a high incidence of gallstones as well as systemic complications of iron overload. We performed laparoscopic cholecystectomy in 8 β thalassemia patients and describe their specific features. Diagnosis was based on patients' clinical presentation and sonography. Trocars were readjusted due to the hepatomegaly. No intraoperative cholangiograms were performed. Follow-up included clinical assessment and abdominal sonography. All procedures were completed laparoscopically. Pigment cirrhosis and fibrosis around the cystic duct were noted in all patients. No biliary injury occurred. Post operatively, 4 patients suffered fluid leakage through the trocar site, treated conservatively. No major cardiopulmonary complications occurred. During a mean follow-up time of 65 months, all patients are symptom free and without evidence of biliary lithiasis. Thalassemia patients are difficult and often high-risk patients. Improvement in anesthesia and monitoring enables better management of these patients. Laparoscopic cholecystectomy should be advised in carefully selected thalassemia patients.
From the Departments of General Surgery (Drs Katz, Muggia, and Gimmon) and Hematology (Dr Goldfarb), Hadassah Medical Center, Hebrew University, Ein Kerem, Jerusalem, Israel.
Received for publication November 27, 2002; accepted June 25, 2003.
Reprints: Ran Katz, MD, Department of Urology Hadassah Medical Center, Ein Kerem PO Box 12000 Jerusalem 91120, Israel (e-mail: email@example.com).