Laparoscopic Cholecystectomy in Obese and Non-Obese Children

Abstract

26 (96%) were female. The average PSV of the positive group was 313 cm/s (229-495 cm/s) compared to the negative group 159 cm/ s(121-189)(p < 0.00001). With deep inspiration the average PSV dropped to 180 cm/s(112-340 cm/s) in MALS patients versus 144 cm/s (97-187 cm/s)(p ¼ 0.001) reflecting an average change in velocity of 132 cm/s versus 15 cm/s(p < 0.00001). Patients with a positive duplex then underwent CTA to confirm findings prior to surgery with a 90% correlation to duplex. 21 patients underwent laparoscopic release with technical success. Post operative duplex revealed a decrease in PSV to 212(126-373 cm/s) (p < 0.00001compared to pre-op) and a change in velocity of 29 cm/s(vs. 132 cm/s p < 0.00001). Of the 21 patients 17 are symptom free with a mean follow up of 6 months. One patient will undergo an angiogram with angioplasty, one patient had post-operative complaints of bloating, one patient had no relief of her symptoms and one patient developed a delayed pancreatitis which resolved, and one patient unmasked a SMA syndrome which resolved with conservative management. Overall scores from the PedsQL tm questionnaire improved from 56(30-85) to 92(72-100). Conclusion: This unexpectedly high proportion of females who screened positively for MALS and early success in QOL outcome measures after surgery lead us to hypothesize that MALS might be earlier diagnosed and possibly treated in pediatric patients with CAP thought to be functional in origin.

Pediatric Obesity and Safety in Inpatient Settings

“…However, no difference in hospital length of stay or rate of perioperative complications was seen between normal-weight, overweight, and obese children in patients undergoing ultrasound for diagnosis of appendicitis 50 or laparoscopic cholecystectomy. 40…”

“…The incidence of other perioperative complications, such as wound dehiscence or postoperative bleeding, was not higher among obese pediatric patients compared with nonobese. 31,32,40 However, small sample sizes and retrospective study design limit the interpretation of these reports.…”