Laparoscopic cholecystectomy in children and adolescents

Abstract

During the period between August 1991 and November 1995, seven patients under age 17 were submitted to videolaparoscopic cholecystectomy (LC). Two were males and five females with ages ranging from 12 to 16 years (mean 13.8 years). The diagnosis of chronic cholecystitis with gallstones was made by the clinical history and physical and ultrasonographic examinations. There was no evidence of an association with hemolytic diseases, familial hyperlipidemia or Glucose-6-phosphate dehydrogenase (G6PD) deficiency. The surgery was performed under general anesthesia and the abdomen approached by four ports: a 10 mm umbilical incision, a 5 mm cystic, a 5 mm one at the xiphoid appendix and a 10 mm one at the left lateral margin of the left rectus abdominal muscle between the umbilical scar and the xiphoid appendix. Operative time averaged 120 minutes (105-150 min). One case required conversion to laparotomic approach because of Mirizzi's Syndrome, which was diagnosed by intraoperative cholangiography performed in all cases. There were no deaths or major postoperative complications. Hospital stays ranged from 1-3 days in the six patients submitted to LC. Thus LC in children can be considered a good method, requiring only more care regarding the use of proper equipment, complete and careful dissection of the biliary hilus, and intraoperative cholangiography. The latter is indispensable, as these children can present a higher rate of anatomic anomalies. The advantages of this technique include a less painful postoperative period with a faster recovery, and it is especially recommended in children, who are less tolerant to physical restriction and pain than adults.

Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes

“…Of these cases, those from Chile had more detailed clinical data and highlighted persistent anaemia with the need for blood transfusions, reticulocytosis, jaundice and splenomegaly [80]. Cholelithiasis is a complication that can follow CNSA, but in Brazil, there was no association between the need for cholecystectomy and G6PDd [83]. In a study from Brazil [84] and in another from Colombia [85], G6PD-deficient subjects showed a lower level of haemoglobin than the normal individuals.…”

Tumor de reto e cárdia sincrônicos: relato de caso e revisão da literatura

“…Segundo os critérios de Warren e Gates; tumores sincrônicos são aqueles que não podem ser considerados metástase, invasão ou recorrência do primeiro, tendo como intervalo entre o diagnóstico do segundo primário tumor menos que seis meses. 2 A possibilidade de se encontrar um tumor sincrônico de cólon é rara 3 . O adenocarcinoma de cárdia merece uma avaliação individualizada, por ser uma zona de transição entre duas cavidades e dois órgãos, possuindo uma peculiar disseminação linfática 3 .…”

“…2 A possibilidade de se encontrar um tumor sincrônico de cólon é rara 3 . O adenocarcinoma de cárdia merece uma avaliação individualizada, por ser uma zona de transição entre duas cavidades e dois órgãos, possuindo uma peculiar disseminação linfática 3 .…”

“…Há pesquisas sobre fatores genéticos, porém as bases moleculares para essa associação ainda não estão bem estabelecidas. 2,3 A carcinogênese para tumores primários múltiplos do sistema digestório está associado com a instabilidade de microssatélites. 4 Não encontramos, na literatura médica pesquisada, caso semelhante ao aqui relatado de tumor sincrônicos de reto e cárdia.…”

“…3 Das neoplasias do sistema digestório o mais comum de apresentar tumor sincrônico é a neoplasia de estômago, em torno de 2,8% a 6% e geralmente a localização é inespecífica. Dos tumores primários do trato gastrintestinal cerca de 27 % são classificados como sincrônicos e 73% como metacrônicos.…”