AIM:To evaluate the role of laparoscopic cholecystectomy (LC) in the management of cholelithiasis in children.MATERIALS AND METHODS:A retrospective review of our experience with LC for cholelithiasis at our institution, between April 2006 and March 2009 was done. Data points reviewed included patient demographics, clinical history, haematological investigations, imaging studies, operative techniques, postoperative complications, postoperative recovery and final histopathological diagnosis.RESULTS:During the study period of 36 months, 22 children (10 males and 12 females) with cholelithiasis were treated by LC. The mean age was 9.4 years (range 3 to 18 years). Twenty-one children had symptoms of biliary tract disease and one child was incidentally detected with cholelithiasis during an ultrasonogram of the abdomen for an unrelated cause. Only five (22.7%) children had definitive etiological risk factors for cholelithiasis and the remaining 13(77.3%) cases were idiopathic. Twenty cases had pigmented gallstones and two had cholesterol gallstones. All the 22 patients underwent LC, 21 elective and one emergency LC. The mean operative duration was 74.2 minutes (range 50-180 minutes). Postoperative complications occurred in two (9.1%) patients. The average duration of hospital stay was 4.1 days (range 3-6 days).CONCLUSION:Laparoscopic chloecystectomy is confirmed to be a safe and efficacious treatment for pediatric cholelithiasis. The cause for an increased incidence of pediatric gallstones and their natural history need to be further evaluated.
Aim:To evaluate the role of laparoscopic cholecystectomy (LC) in the management of cholelithiasis in children.Methods:A retrospective review of our experience with LC for cholelithiasis at our institution, between April 2006 and November 2008, was done. Data included patient demographics, clinical history, hematological investigations, imaging studies, operative technique, postoperative complications, postoperative recovery, and final histopathological diagnosis.Results:During the study period of 32 months, 18 children (8 males and 10 females) with cholelithiasis were treated by LC. The mean age was 9.4 years (range 3–18). Seventeen children had symptoms of biliary tract disease and 1 child had incidentally detected cholelithiasis during an ultrasonography of abdomen for unrelated cause. Only 5 (27.8%) children had definitive etiological risk factors for cholelithiasis and the remaining 13 (75.2%) cases were idiopathic. Sixteen cases had pigmented gallstones and 2 had cholesterol gallstones. All the 18 patients underwent LC, 17 elective, and 1 emergency LC. The mean operative duration was 74.2 min (range 50–180). Postoperative complications occurred in 2 (11.1%) patients. The average duration of hospital stay was 4.1 days (range 3–6).Conclusion:Laparoscopic chloecystectomy is a safe and efficacious treatment for pediatric cholelithiasis. The cause for increased incidence of pediatric gallstones and their natural history needs to be further evaluated.
Aims:Primary cysts and tumors of the ovary alongwith torsion are often regarded as an indication for open oophorectomy because of the fear of leaving an ischemic organ inside and chances of recurrence. We wish to report our experience of both modalities of management where we initially removed adenexal torsion by either laparoscopic salpingo-oophorectomy or oophorectomy, but later followed a more conservative approach of adenexal lesion removal with ovarian preservation.Materials and Methods:Retrospective review of clinical records of patients with ovarian pathology who were managed laparoscopically.Results:46 cases of pediatric ovarian pathology were managed between March 2006 and March 2013 in two centers by a team of surgeons. The age ranged from 1 days to 18 years (average 14.3 years) and the pathology varied from 30 cases of a simple ovarian cyst with torsion, 3 cases of ovarian torsion without any cyst, 7 cases of a dermoid cyst with torsion in all, 1 case of secreting ovarian tumor and 5 cases of a paraovarian cyst with torsion. All patients had a normal tumor marker except 1 girl with a functional ovarian tumor who had elevated LDH and estrogen levels alongwith suppressed LH and FSH. In the initial period of our study we did 1 salpingo-oophorectomy for a suspected complex lesion and two oophorectomies for torsion with a simple cyst. In the later part of our study we performed laparoscopic cystectomy and ovarian preservation in 40 cases, including 7 cases of dermoid, where we performed laparoscopic detorsion with dermoid cystectomy and ovarian preservation in the same sitting. In three cases of chronic torsion who presented to us late, we could not preserve the ovary and had to resort to salpingo-ophorectomy. Histology showed a simple corpus luteal and follicular ovarian cyst in 31 cases, a paraovarian cyst in 5 cases with mature teratoma in 7 cases. Twenty-five patients with ovarian preservation following detorsion were subjected to follow-up ultrasound, who were found to have normal shape, size and blood flow compared to the contra lateral side.Conclusion:We outline our experience from the management of 46 cases of various ovarian pathologies with and without ischemia and found that ovarian torsion with a benign pathology and ischemia is not a contraindication for ovarian preservation, as pointed out in the current literature.
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