Laparoscopic Cholecystectomy for Cholelithiasis during Infancy and Childhood: Cost Analysis and Review of Current Indications

Abstract

Eleven consecutive laparoscopic cholecystectomies (LCs) were performed between January 1994 and June 1996 compared with seven open cholecystectomies (OCs) performed previously at King Khalid University Hospital. The comparison included surgical, clinical, and economic factors, together with a review of the literature. In the laparoscopic group the main indication for cholecystectomy was symptomatic gallstones. Other indications include mucocele of the gallbladder and chronic cholecystitis. A total of eight children in both group had sickle cell disease. The first two LCs were performed in the presence of an experienced laparoscopic surgeon. There is a learning curve to pass through with LC. The operating time for LC ranged between 65 and 135 minutes (mean +/- SD 89.81 +/- 21.89 minutes). There was no major morbidity or mortality. The average postoperative parenteral analgesia required for LC (50.45 +/- 24.57 mg) was significantly less than for OC (135.14 +/- 62.02 mg), and the mean length of hospitalization for LC was significantly shorter than that for OC (1.68 +/- 0.46 vs. 6.07 +/- 0.30) days. Although the average operative cost per LC (2522 SR) was significantly more expensive than for OC (350 SR), the ultimate cost of LC was significantly less than for OC (5790.00 +/- 787 vs. 12,343 +/- 139 SR) because the total period of hospitalization was much shorter. In conclusion, LC is safe, effective, and less expensive than OC and therefore is the approach of choice for cholecystectomy in children.

Role of laparoscopic cholecystectomy in children

“…Therefore, laparoscopic cholecystectomy is safe and effi- Kim et al [5] Newman et al [6] Jawad et al [7] Present study cacious in children, and it compares favorably with traditional open cholecystectomy in the pediatric age group.…”

Laparoscopic surgery in children

“…Though there was an increased incidence in intra-abdominal surgical procedures (20%) compared to extracavitary procedures, no difference was observed whether the procedure was open or laparoscopic. Jawad et al 20 compared open ( n = 7) and laparoscopic cholecystectomy ( n = 11) and found reduced postoperative analgesic requirement and a reduced hospital stay in the latter group.…”

“…The initial series were simply observational in small groups of patients [14][15][16][17] or small groups compared with historical controls. [18][19][20] More recently, series of more than 100 children have been reported 21,22 albeit often from combined centres. All series show that LC is safe with a low risk of complications and probably reduces hospital stay.…”

Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy

“…The benefits of LC over open cholecystectomy have been well established for paediatric cohorts, reducing costs, post-operative hospitalisation, complications, and analgesia use [12] [13]. As with adults, the role of OTC has now come into question, bringing with it both advocacy and opposition.…”

“…The LC approach developed for adult surgery has now been well adopted by paediatric surgeons in the UK, with retrospective studies strongly advocating its use over open cholecystectomy [8][9][10][11][12][13]. LC is now chosen to minimise use of analgesics, reduce complications and to improve cosmesis [1] [9].…”