Evaluation and management of cholelithiasis in children: a hospital based study

Abstract

INTRODUCTIONCholelithiasis is quite common in adults (10% to 20%) with worldwide variability. In India, it is 3% to 6%, more frequent in north India than in south India.1 As far as cholelithiasis in children is concerned there is a dramatic change in the overall spectrum of this disease with global increase in the incidence.2 Overall prevalence in Europe is 0.13% to 0.2% in children. In Japan, it is less than 0.13% of children & about 0.3% in India.3,4 Childhood cholelithiasis is evolving with an ever increasing frequency of cholecystectomies in children. 5 Risk factors in childhood cholelithiasis, can be hemolytic causes (20-30%), other known etiology (40-50%) such as total ABSTRACT Background: Earlier cholelithiasis was extremely unusual in childhood. Presently there is sharp increase in detection of cholelithiasis in children, which forms basis to investigate the overall changing pattern of cholelithiasis. This prospective study in referral centre has been under taken to evaluate childhood cholelithiasis and its management. Methods: The present prospective study was conducted in the Postgraduate Department of Surgery, GMC Jammu, Jammu & Kashmir, India over a period of two years. 80 patients in age group of 3-14 years were included in the study group with ultrasound proved cholelithiasis. Data reviewed with respect to patient demographics profile, clinical history including risk factors, imaging studies, operative techniques, postoperative complications, postoperative recovery and primary outcome parameters assessed accordingly. Results: During the study period 80 children (52 males and 28 females) with cholelithiasis were evaluated and treated by laparoscopic cholecystectomy. The mean age was 10.1 years (range 5 to 14 years). 75% patients (n = 60) belonged to rural background and rest to urban set up, 56 patients belonged to hindu religion and rest were muslims. In 47.5% patients no risk factor could be traced. Fifty two children (65%) had mixed gallstones. 78 patients underwent LC, two needed conversion and rest 02 children were subjected to mini cholecystectomy. The mean operative duration was 29.92 minutes (range 15-50 minutes). The average duration of hospital stay was 3.82 days (range 3-8 days). No major intra operative or post-operative complications could be detected except 01 case biliary peritonitis. Conclusions: Cholelithiasis in children was reported about three centuries back, remained relatively uncommon in the past but now it is evolving and ever increasing in frequency. In this part of country in almost 50% of patients risk factors could not be traced, obesity could not be held responsible for cholelithiasis. Male children with low socioeconomic status, rural area and belonging to Hindu religion were more affected by the disease. In view of high incidence of serious complications of gall stones in children and because of longer life expectancy we also recommend that expectant management of gallstones may not be safe and hence laparoscopic cholecystectomy must be done even in asymptomatic cholel...

Paediatric cholelithiasis: our experience at a tertiary care centre

“…Although Gibson reported the first case of paediatric cholelithiasis as early as 1737, it was found to be an uncommon pathology in children 5 . Recently however, several investigators have reported an increase in its frequency and the resultant cholecystectomy [6][7][8][9] . Incidence of gallstone disease in India is 0.3% with less than 0.1% in the 0-10 year age group 10,11 .…”

“…Risks of laparoscopic cholecystectomy include CBD injury, bile leak, bleeding, wound infection, retained stones. Several series report minimal complication rates 7,12,18 . St Peter et al 19 and Tannuri AC, et al 20 , in their studies reported no conversions, ductal injuries, bile leaks, or deaths.…”

“…Asymptomatic paediatric gallstone cases are an important subgroup, comprising 4-24% in several series; these cases present with management related dilemmas 6,7,34 . Several investigators have reported regression of stones and sludge in infants and in children less than three years of age, thereby advocating non-operative follow-up with periodic USG abdomen 6,35 .…”

“…According to some other series, cholecystectomy is advised for all asymptomatic children more than 3 years of age if ultrasonography confirms that echogenic foci with shadowing are true stones and not echogenic sludge, to prevent complications of CBD obstruction, pancreatitis, perforation with bile peritonitis, and life-threatening sepsis 15,39 . There is a unanimous decision on symptomatic gallstones in children that it should be dealt surgically and laparoscopic cholecystectomy is the gold standard treatment for children as well [6][7][8]18,40 . Morbidity and mortality following cholecystectomy are expected to be relatively low in the paediatric age group.…”

Kolelitiazisli Çocuk Olgularin Değerlendirilmesi: 10 Yıllık Tek Merkez Deneyimi

“…Literatürle uyumlu şekilde karın ağrısı hastaların 37'sinde (%46,8) olmak üzere en sık gözlenen semptomdu. 9,15,16 Hastalarımızın % 24'ünde taş boyutu >1 cm idi. Taş boyutu 1 cm'nin üzerinde olan hastaların 6'sında obezite, 3'ünde hemolitik anemi ve 4'ünde seftriakson kullanımı öyküsü mevcuttu.…”