1594 Laproscopic Cholecystectomy in the Pediatric Population: A Single Center Experience

Abstract

Background and Aims The aim of this study was to determine an appropriate postnatal management plan for prenatally diagnosed BCM including cystic biliary atresia (BA) and choledochal cyst (CC). Methods From 2002 to 2011, a total of 27 consecutive children with CC were treated at our institute. Eight of our 27 patients with CC were diagnosed prenatally and examined clinically. Of these 8 patients, 2 (Group A) underwent delayed primary definitive surgery after percutaneous transhepatic cholangiodrainage (PTCD), 2 (Group B) underwent early definitive surgery in the neonatal period, and 4 (Group C) underwent delayed primary definitive surgery without PTCD in early infancy. Prenatally diagnosed cystic BA was consisted with 2 of patients with type 1 cystic BA (Group D). Results The operation was difficult for adhesion in Group A. The diameter of the anastomosis in the hepaticojejunostomy was small and anastomotic leakage occurred in one of Group B. In all 2 patients, BA was recognized as final diagnosis at laparotomy and a hepaticojejunostomy was carried out because of correctable type. The pathological findings of liver biopsy revealed slight fibrosis of Glisson's sheath in 6 of 8 CC patients. Severe liver fibrosis presented in one of two in cystic BA patients. Conclusion In symptomatic CC patients, PTCD appears to be indicated only under certain circumstances, and delayed primary definitive surgery should be performed as early as possible thereafter. Clinicians need to be aware of cystic BA and how to distinguish it from CC to avoid inadequate primary surgical intervention.

Feasibility and outcomes of 3-port laparoscopic cholecystectomy in the pediatric population

“…6 Authors considered the 3-port approach to be mostly sufficient for cholecystectomy with a need for conversion to open cholecystectomy in 3 patients and postoperative complications due to failure of bile drainage in 3 patients (6). Accordingly, our findings are consistent with findings from published series of pediatric patients indicating efficacy and safety of laparoscopic cholecystectomy that results in short postoperative hospital stay and low complication rates (6)(7)(8)(9)14). Our findings also support the higher prevalence of idiopathic cholelithiasis as well as the association of cholelithiasis, particularly pigment stones containing bilirubin salts, with hemolytic disorders in the pediatric population (7,8,(14)(15)(16)(17) and the safety of laparoscopic cholecystectomy in the case of symptomatic cholelithiasis in pediatric patients with hemolytic disorders (5,18).…”

“…In another retrospective study of 202 pediatric patients with laparoscopic cholecystectomy, symptomatic cholelithiasis was reported to be the primary (46%) indication with concomitant splenectomy in 7.9% of patients. 9 Authors reported no common bile duct injuries, whereas spillage of bile in 5.9% and wound infection, retained stones, abdominal abscess, and biloma in 4.5% of patients (9). The median operative time and postoperative LOS were reported to be 117.5 minutes and 1 day, respectively (9).…”

“…9 Authors reported no common bile duct injuries, whereas spillage of bile in 5.9% and wound infection, retained stones, abdominal abscess, and biloma in 4.5% of patients (9). The median operative time and postoperative LOS were reported to be 117.5 minutes and 1 day, respectively (9). Notably, the mean operative time in our series during 3-port laparoscopic cholecystectomy seems to be shorter (44.8 min, range 30.0-60.0).…”

Management of Gallstones in the Pediatric Patient

“…In a large retrospective series, Kelley-Quon et al [ 38 ] found a 0.36 % incidence of bile duct injury. Zeidan and colleagues [ 34 ] reported no bile duct injuries in 202 children undergoing LC. Thus, LC is safe and effective in children and there is no age-specifi c reason for children to be subjected to an open procedure.…”

Morbilidad en Pacientes Pediátricos Sometidos a Colecistectomía Laparoscópica

“…En esta serie, un 84% son niñas; cifra superior a la reportada en otras series [4][5][6][12][13][14][15] . La coexistencia de coledocolitiasis (8,5% de los casos), es comparable con otras experiencias, tanto pediátricas como de adultos, por lo que no parece haber diferencia en la presentación de esta comorbilidad en este grupo de edad 13,16 . La morbimortalidad registrada, es similar a series de adultos, contrario a lo que uno pudiese pensar por ser sujetos anatómicamente más pequeños, hecho que pudiera significar un mayor riesgo de MPO 4,17 .…”