**4.1 Cases**

It is believed that minimally invasive therapy can reduce morbidity and mortality in sickle cell disease patients. The safety of laparoscopic cholecystectomy in such patients has already been recognized. Rachid et al [10] reported the results of their experience on laparoscopic cholecystectomy in sickle cell disease patients in Niger, which is included in the sickle cell belt. Their study covered 45 months and included 47 patients operated by the same surgeon. The average age was 22.4 years (range: 11 to 46 years) and eleven (23.4%) of them were aged less than 15 years. The types of sickle cell disease found were 37 SS, 2 SC, 1 S betathalassemia and 7 AS. The indications for their surgeries were biliary colic in 29 cases (61.7%) and acute cholecystitis in 18 cases (38.3%). Their mean operative time was 64 minutes. Reports from the authors states that there were conversions to open cholecystectomy in 2 cases (4.2 %) for non recognition of Calot's triangle structures. They reported four cases of postoperative complications of vaso-occlusive crisis and one case of acute chest syndrome. Their mean postoperative hospital stay was 3.5days (range: 1 to 9 days). There was no mortality encountered. The authors concluded that laparoscopic cholecystectomy is a safe procedure in sickle cell patients and that it should be a multidisciplinary approach and involve the haematologist, anaesthesiologist and a surgeon.

Haberkem et al [12] studied a group of 364 patients who underwent cholecystectomy. There were ninety-eight percent of their patients who had symptomatic cholelithiasis. Their total perioperative morbidity was 39% and they reported that while total morbidity is not affected by preoperative transfusion, the incidence of specific sickle cell events is higher in those patients who were not transfused preoperatively than in those who were. Laparoscopic cholecystectomy was accompanied by shorter hospitalization time (6.4 days) than the open cholecystectomy (9.8 days) and noted that perioperative outcomes were the same with both techniques. The authors concluded that conservative preoperative transfusion and use of the laparoscopic technique are necessary for patients with sickle cell disease who will be undergoing cholecystectomy to prevent further complications.
