Factors Associated With Outcomes and Costs After Pediatric Laparoscopic Cholecystectomy

Akhtar-Danesh, Gileh-Gol; Doumouras, Aristithes G.; Bos, Cecily; Flageole, Hélène; Hong, Dennis

doi:10.1001/jamasurg.2017.5461

Cited by 27 publications

(26 citation statements)

References 22 publications

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“…Prolonged obstruction results in inflammation, infection, and even ischemia, resulting in acute inflammation of GB; repeated episodes can result in chronic cholecystitis, in which a thickened GB wall, GB mucosal atrophy and scarring were detected (16). There is no consensus on the management of children with cholelithiasis and the risks of developing complications as a consequence of delaying surgery are well-known (17)(18)(19). More than 70% of cases admitted in emergency became symptomatic when surgery is delayed after a mean time of 38 months.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing

et al. 2020

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Background: Laparoscopic cholecystectomy (LC) is the standard of care for gallbladder (GB) pathologies. We evaluated clinical, ultrasonographic (US) data as well as histopathological findings in children affected with symptomatic cholecystic disease (SCD) who underwent LC, with the aim of defining surgical timing. Methods: We reviewed our cases who underwent elective LC (ELC) or urgent LC (ULC). Clinical, US, surgical and histological features were used to create different risk scores. Results: We considered 26 children (17 ELC/9 ULC). US signs were not different in the two groups (p > 0.05). Operating times were longer in ELC than in ULC (p = 0.01). Histopathological evaluation revealed fibrosis and atrophy in both ELC and ULC. The clinical risk score was higher in ELC compared to ULC (p < 0.001). An increased operative risk score was noted in patients with systemic inflammatory signs (OR1.98), lithotherapy (OR1.4.3) and wall thickening ≥3 mm (OR2.6). An increased histopathological risk score was detected in children with symptom duration >7 days (OR3.61), concomitant hematological disease (OR1.23) and lithotherapy (OR3.61). Conclusion: Criteria adopted in adults cannot be adopted to detect the severity of GB damage in children. A dedicated clinical and US score is mandatory to define the most appropriate surgical timing.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing

et al. 2020

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“…TG18 advocates definitive surgical intervention (usually laparoscopic cholecystectomy) on the index admission in patients with acute cholecystitis or biliary pancreatitis, citing both prospective longitudinal studies and retrospective observational studies that demonstrated a significantly lower incidence of disease recurrence, hospital readmission, and overall disease-specific complications when the procedure was performed within 7 days of the onset of symptoms in the appropriate patient (recommending within 72 h as preferable) 5,17,[23][24][25][26][27][28][29][30] . However, 15 (60 per cent) of the 25 centres in the present study estimated that less than half of their patients routinely had index admission cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

Self-reported and actual adherence to the Tokyo guidelines in the European snapshot audit of complicated calculous biliary disease

et al. 2020

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Background: Complicated acute biliary calculous disease poses clinical challenges. The European Society of Trauma and Emergency Surgery (ESTES) snapshot audit of complicated biliary calculous disease aims to make novel comparisons between self-reported institutional adherence to the Tokyo guidelines (TG18) and 'real-world' contemporary practice across Europe. Methods: A preplanned analysis of a prospective observational multicentre audit that captured patients undergoing emergency admission for complicated biliary calculous disease (complicated cholecystitis, biliary pancreatitis, or choledocholithiasis with or without cholangitis) between 1 and 31 October 2018 was performed. An anonymized survey was administered to participating sites. Results: Following an open call for participation, 25 centres from nine countries enrolled 338 patients. All centres completed the anonymized survey. Fifteen centres (60 per cent) self-reported that a minority of patients were treated surgically on index admission, favouring interval cholecystectomy. This was replicated in the snapshot audit, in which 152 of 338 patients (45⋅0 per cent) underwent index admission cholecystectomy, 17 (5⋅0 per cent) had interval cholecystectomy, and the remaining 169 (50⋅0 per cent) had not undergone surgery by the end of the 60-day follow-up. Centres that employed a dedicated acute care surgery model of care were more likely to perform index admission cholecystectomy compared with a traditional general surgery 'on call' service (57 versus 38 per cent respectively; odds ratio 2⋅14 (95 per cent c.i. 1⋅37 to 3⋅35), P < 0⋅001). Six centres (24 per cent) self-reported routinely performing blood cultures in acute cholecystitis; patient-level audit data revealed that blood cultures were done in 47 of 154 patients (30⋅5 per cent). No centre self-reported omitting antibiotics in the management of acute cholecystitis, and 144 of 154 (93⋅5 per cent) of patients in the snapshot audit received antibiotics during their index admission. Conclusion: Awareness of TG18 recommendations was high, but self-reported adherence and objective snapshot audit data showed low compliance with TG18 in patients with complicated acute biliary calculous disease. Funding information No funding * Members of the ESTES Cohort Studies Group are co-authors of this study and may be found under the heading Collaborators.

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“…From 1722, when the first case of cholelithiasis was reported in an autopsy done to a 12-year-old boy, this problem has increasingly interested pediatric surgeons [ 5 , 6 ]. The biliary lithiasis has a multifactorial genesis, with a large family component, characterized by alteration of cholesterol homeostasis and metabolism of the salts contained in the bile that precipitate forming the calculations.…”

Section: Discussionmentioning

confidence: 99%

“…The biliary lithiasis has a multifactorial genesis, with a large family component, characterized by alteration of cholesterol homeostasis and metabolism of the salts contained in the bile that precipitate forming the calculations. Cholelithiasis is often linked to hemolytic diseases that alter the solubility of bile salts, but today the form is not only increasing due to hematological diseases, but also due to the growing problem of pediatric obesity and use of particular drugs [ 6 , 7 ]. In the series, the authors took into consideration the cholecystectomies performed in patients with cholelithiasis unrelated to hemolytic diseases in order to analyze the predisposing factors and the results of the surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Cholelithiasis Unrelated to Hematological Disorders in Pediatric Patients Undergoing Cholecystectomy

et al. 2018

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BackgroundPediatric cholelithiasis unrelated to hematological disorders is an increasing disease. We analyzed our experience in the surgical treatment of these cases to evaluate risk factors, clinical presentation, intervention and follow-up.MethodsFrom January 2010 to December 2016, we retrospectively recorded all data (hematological study, familiarity, use of lithogenic drugs and parenteral nutrition) of cholecystectomies for cholelithiasis not related to hematological diseases. The body mass index (BMI) was calculated (obesity if > 25), medical treatment, surgery and follow-up were evaluated. All patients underwent ultrasound for diagnosis and major biliary tract assessment prior to surgery. All patients had a 1-year follow-up.ResultsThere were twenty-four cases (eight males), with a median age of 11.2 years. Predisposing factors were familiarity in 19, use of lithogenic drugs in 5 and total parental nutrition (TPN) in 3. Median BMI was 19.8 kg/m2, with BMI > 25 kg/m2 in eight cases. Regarding the clinical presentation, 14 had acute pain in the right upper quadrant, 5 had cholecystitis and 5 had non-specific abdominal pain. The medical treatment lasted 6 months in all, except for five (three operated after 2 months and two after 12 months). Preoperative ultrasound did not show stones in the biliary tract. MRI was performed in three cases for suspected malformation of the biliary tract (negative). Laparoscopic cholecystectomy was performed in all cases: mean intervention time was 95 min. A case of postcolecystectomy syndrome was found. At follow-up, all were asymptomatic, except two (recurrent abdominal pain).ConclusionMain predisposing factors are familiarity and obesity. Preoperative ultrasound in our series replaced the intraoperative study of the biliary tract. Laparoscopic cholecystectomy is the gold standard.

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Factors Associated With Outcomes and Costs After Pediatric Laparoscopic Cholecystectomy

Cited by 27 publications

References 22 publications

Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing

Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing

Self-reported and actual adherence to the Tokyo guidelines in the European snapshot audit of complicated calculous biliary disease

Risk Factors of Cholelithiasis Unrelated to Hematological Disorders in Pediatric Patients Undergoing Cholecystectomy

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