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

Abstract

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.

Weekend Admissions Associated with Increased Length of Stay for Children Undergoing Cholecystectomy

“…The central challenge to reducing variability in treating children with gallbladder diseases requiring surgery is standardizing and defining the optimal initial diagnostic test, the timing of therapeutic cholecystectomy, and the postoperative care, which is not thoroughly defined as in adult gallbladder disease. 7 Further research should investigate how to provide quality surgical care as uniformly as possible throughout weekday and weekend hospitalizations and further investigate temporal variations in the delivery of care in surgical urgent and emergent cases in the pediatric population. …”

“… 3 , 4 Currently, few resources exist on the standardization of care for pediatric benign noncongenital gallbladder disease with variation in the modality of diagnosis, laboratory follow-up, procedural/operative interventions, and timing of treatment strategies, leading to significant variation among hospitals. 5 – 7 While adult cases have been studied to determine optimal timing for surgical intervention and develop systematic methods for efficient medical decision-making, there is less evidence of this in children. 8 This leads to significant variation in who admits these children—a surgical or medical service—, how urgent they should be treated, and what follow-up they receive.…”

Litíase biliar em lactente: um relato de caso

“…A obstrução prolongada resulta em inflamação, infecção e, até mesmo, em isquemia. Episódios repetidos de inflamação aguda, resultado da colelitíase biliar pode agravar para um quadro de colecistite crônica, podendo detectar uma parede espessa, atrofia da mucosa e cicatrizes na vesícula biliar (PELIZZO et al, 2020).…”

“…A laparoscopia é também uma escolha para cálculos biliares em pacientes pediátricos sintomáticos, sendo uma técnica menos invasiva, apresentando menor dor pós-operatória, curto período de recuperação e melhores resultados que a colecistectomia aberta (PELIZZO et al, 2020).…”

An Overview on Thalassemia Diagnosis and Management Approach, Literature Review

“…Splenectomy limits the number of blood transfusions and regresses the spread of extramedullary hematopoiesis [26]. Cholelithiasis can occur in thalassemia after Hemoglobin breakdown and the influence of bilirubin deposition in the gallbladder if it becomes symptomatic patients should undergo cholecystectomy with splenectomy [27]. Follow-up thalassemic patients are asked to monitor the progress of the disease as its recommended to have a clinical visit every month for routine physical and clinical laboratory assessments.…”