OBJECTIVE: Surgical procedures are often required in si-ckle cell anemia (SCA). Patients with SCA are recognized as having a relatively higher risk for postoperative comp-lications. The aim of the present study was to evaluate the preoperative and postoperative management of pa-tients with SCA undergoing surgery. MATERIALS AND METHODS: The medical records of all children with SCA who had surgery at our hospital were retrospectively reviewed for the following: age, gender, preoperative investigations, and postoperative compli-cations. RESULTS: From 2012 to 2014, 12 children with SCA had surgery at our hospital. The patients’ mean age was 12.1 years (range, 6–17). Five patients were female. The surgical procedures were cholecystectomy (n=6), tonsillectomy/ adenoidectomy (n=3), splenectomy (n=2) and excision of ovarian cyst (n=1). In a patient who had undergone sple-nectomy, concomitant cholecystectomy were also per-formed. Patients received simple packed red blood cell transfusion (n=1) or total exchange transfusion (n=10) before the surgery. One patient was not transfused which was already enrolled in a chronic transfusion program. All patients received intravenous hydration the night before the surgery and postoperatively. The mean postoperati-ve hospital stay was 5.3 days (range, 3-10). There were no vaso-occlusive crises or deaths. CONCLUSIONS: Children with sickle cell disease presen-ting for elective surgery should be given a transfusion for a hemoglobin S ratio less than 40% in an attempt to redu-ce postoperative complications. With good preoperative and postoperative management, surgery is both safe and effective for children with SCA