Laparoscopic cholecystectomy for cholelithiasis in children

Abstract

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.

Trend of Pediatric Cholecystectomy: Clinical Characteristics and Indications for Cholecystectomy

“…The present study found that laparoscopic cholecystectomy was performed only in 15.4% of the early group, whereas it was performed in 79.4% of the late group. Previous studies reported that laparoscopic cholecystectomy took, on average, 70-90 minutes [18,19], and the present study found a similar result, a mean length of 72.0±58.8 minutes. Laparoscopic procedures have already been proven to be a safe and efficient treatment in pediatric patients with gallstone disease, and the use of laparoscopic procedures is expected to continuously increase.…”

Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy

“…In support of our study, a similar retrospective review of 18 children undergoing LC in India also abstained from any form of OTC across a 32-month period [16]. In their study OTC was not deemed necessary and therefore simply not performed.…”

Laparoscopic cholecystectomy in childhood: a review of twenty-four consecutive cases

“…Although it has been reported to be usually to hemolytic diseases (10-40% higher as compared to normal population), the leading cause of gallbladder stone is generally idiopathic in published series and reported to be detected incidentally while investigating other abdominal pathologies [3]. On the other hand, it may also be seen in premature babies or children who have encountered severe nutritional problems and parenteral nutrition, serious abdominal surgery, familial predisposition, cystic fibrosis, ceftriaxone therapy, obesity, dehydration, endocrine disorders, genetic liver diseases or it may be dietinduced [4,5]. The patients included in this study had undergone hematologic and gastroenterologic investigations preoperatively; no hemolytic, endocrinologic or metabolic disorder was detected.…”

“…Related studies in the field have suggested that 80% of the gallbladder stones is symptomatic in adults whereas only 10-33% is symptomatic in children [4]. Esposito et al [3] stated that non-calcified stones may spontaneously resolve within 3-6 months.…”

“…Conventional cholecystectomy is performed through the open technique using a subcostal or midline incision; however, extended hospital stay and prolonged wound healing are inevitable in open procedures [4]. Since 1987, the year when it was first performed on an adult patient; laparoscopic cholecystectomy has been increasingly used in gallbladder pathologies [12].…”