Types of Thalassemia predict the optimal time of surgery for biliary stone in Children.

Introduction: Biliary stone is the most common surgical problem in thalassemia (thal) children. The optimal time for surgery is currently unknown, it should be delayed as long as the patients remain asymptomatic. This study aimed to determine the optimal time of biliary stone surgery according to type of thalassemia. Method: This is a retrospective study of the 56 patients younger than 18 years who underwent surgery for biliary stone disease in Srinagarind Hospital between 2006-2016. There were 39 thalassemia patients. Of these, 8 patients of unknown type of thalassemia were excluded. We classified the remains (31 patients) into 5 groups as follow: 16 β thal E (51.6%), 4 Hb H-CS (12.9%),4 Hb AE Bart’s-CS (12.9%),3 other major thal (9.6%) and 4 other minor thal (12.9%). All clinical and surgical data were analyzed. Result: The respective minimal age of stone detection for β thal E, Hb H-CS, Hb AE Bart’s-CS, other major and other minor thal was 3, 12, 10, 12 and 8 years. The minimal age (years) of symptom occurrence was 9 for β thal E, 12 for Hb H-CS and 12 for other major thal. There was no symptom observed in Hb AE Bart’s-CS and other minor thal until 15 years of life. Half of the patients with Hb H-CS experienced symptom, and required surgery before 15. Conclusion: Type of thalassemia could predict optimal time of surgery. We suggest the surgery can be deferred until 15 for Hb AE Bart’s-CS and Other minor thal, or until 9 regardless of types of thalassemia.