Both ERCP and laparoscopic cholecystectomy may be necessary if common duct and gallbladder stones are present. The question of whether preoperative transfusion is necessary before major abdominal surgery is discussed in Chapter 10, Transfusion. An intraoperative cholangiogram is recommended to rule out intrahepatic or common duct stones. Postoperative Care Postoperative complications may be more common in sickle cell anemia patients than in the general population and include atelectasis, pneumonitis, and pulmonary infarction. Preoperative and postoperative physiotherapy using an incentive spirometer, plus early ambulation, may reduce the frequency of these complications.
Most patients have an uneventful recovery from surgery.
There is no evidence that surgical wound healing is delayed in patients with sickle cell disease. The patient who presents with right upper quadrant abdominal pain, increased jaundice, and fever needs careful evaluation and management. Episodes of hyperbilirubinemia may occur in the absence of abdominal pain or other symptoms and may have a benign self-limited course resolving in 1 to 2 weeks. In other cases, liver dysfunction is associated with fever, leukocytosis, and a clinical presentation similar to that seen in drug-induced cholestasis. In children and adults, the liver may be the site of red blood cell sequestration during a vaso-occlusive crisis, with increased jaundice, an acutely enlarged tender liver, and a fall in hemoglobin and hematocrit.