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Results and complications of laparoscopic cholecystectomy in childhood
C Esposito1, M A Gonzalez Sabin, F Corcione
1Department of General and Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy. ciroespo@cds.unina.it
Insights
Laparoscopic cholecystectomy is effective for pediatric symptomatic cholelithiasis. Careful dissection and knowledge of biliary abnormalities are key to minimizing complications in children undergoing this procedure.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Symptomatic cholelithiasis (gallstones) is increasingly diagnosed in pediatric populations.
- Laparoscopic cholecystectomy offers a minimally invasive approach for gallbladder removal.
Purpose of the Study:
- To evaluate the outcomes and complications of laparoscopic cholecystectomy in a series of 110 pediatric patients.
- To assess the safety and efficacy of this surgical technique in children.
Main Methods:
- A retrospective case series of 110 pediatric patients undergoing laparoscopic cholecystectomy over a 5-year period.
- Patients ages ranged from 1 to 16 years, with symptomatic cholelithiasis confirmed by ultrasound.
- Associated pathologies included sickle cell disease, hereditary spherocytosis, and thalassemia.
Main Results:
- The median operative time was 45 minutes, with a median hospital stay of 2 days.
- A total of 17 complications (15.5%) were recorded, including gallbladder perforation and trocar site infections.
- All patients were reported to be doing well at a maximum follow-up of 5 years.
Conclusions:
- Laparoscopic cholecystectomy is an effective treatment for symptomatic cholelithiasis in children.
- Precise surgical technique and awareness of potential congenital biliary abnormalities are crucial for preventing complications in pediatric patients.
Background:
The purpose of our study was to evaluate the results and complications of laparoscopic cholecystectomy in a case series of 110 infants.
Methods:
Over a 5-year period (1993-98), we performed laparoscopic cholecystectomy in 110 pediatric patients. Surgery was performed at different institutions by three different surgeons. The patient population was composed of 69 girls and 41 boys; their ages ranged from 1 to 16 years (median, 8.5). All of the 110 children had symptomatic cholelithiasis, which was confirmed at ultrasound examination. An associated pathology was present in 27 patients (sickle cell disease in 17 cases, hereditary spherocytosis in seven cases, thalassemia in three); the other 83 infants were affected by idiopathic cholelithiasis. In 107 patients, the operation was performed using four ports; in three patients, it was done using five ports. In three patients, we also performed a concomitant splenectomy.
Results:
Median duration of simple cholecystectomy was 45 min (range, 25-75) and hospital stay ranged from 1 to 10 days (median, 2). Only 15 children required drainage. We had 17 complications in our series (15.5%), including a gallbladder perforation during dissection in 11 patients, a fall of stones into the abdominal cavity during extraction in one patient, and a trocar orifice infection in the postoperative period in five patients. At a maximum follow-up of five years (range, 1-5), all patients were doing well.
Conclusion:
Laparoscopic cholecystectomy in children seems to be as effective as open surgery in cases of symptomatic cholelithiasis. In pediatric patients more than in adults, an accurate and precise dissection and a sound knowledge of possible congenital biliary abnormalities are essential to avoid any kind of complication.