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Updated: Oct 4, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Outcome after laparoscopic cholecystotomy and cholecystectomy in children with symptomatic cholecystolithiasis: a
B M Ure1, M M de Jong, K N Bax
1Abteilung Kinderchirurgie, Medizinische Hochschule Hannover, Germany.
Insights
Laparoscopic cholecystotomy (LCO) may offer a better outcome for children with symptomatic gallstones than laparoscopic cholecystectomy (LCE). Further research is needed to confirm long-term results for this alternative procedure.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy (LCE) is standard for pediatric symptomatic gallstones.
- Concerns exist regarding LCE's long-term disadvantages, including postoperative symptoms and potential links to colon cancer.
- Laparoscopic cholecystotomy (LCO), preserving the gallbladder, is proposed as an alternative.
Purpose of the Study:
- To compare the functional and symptomatic outcomes of LCO versus LCE in children with symptomatic gallstones.
- To evaluate the feasibility and safety of LCO as an alternative to LCE in pediatric patients.
Main Methods:
- A follow-up study of children undergoing surgery for symptomatic gallstones between 1993 and 1999.
- Nine patients underwent LCO, and 8 underwent standard LCE.
- Standardized follow-up interviews assessed gastrointestinal symptoms and overall outcome using visual analogue scales.
Main Results:
- No intraoperative complications were reported for either procedure.
- Mean hospital stay was slightly longer after LCO (3.0 days) compared to LCE (2.4 days).
- A trend towards fewer symptoms was observed after LCO (3/8 patients) compared to LCE (5/8 patients) at a mean follow-up of 20.7 months for LCO and 28.3 months for LCE.
Conclusions:
- Laparoscopic cholecystotomy (LCO) appears to be a viable alternative for treating symptomatic gallstones in children, particularly before puberty.
- While initial results suggest a potential for fewer symptoms, larger studies are required to validate long-term outcomes.
- Further data are essential before LCO can be broadly recommended for pediatric gallstone disease.
Abstract:
Laparoscopic cholecystectomy (LCE) has become the procedure of choice for symptomatic gallstones in children. However, there is concern about the disadvantages of cholecystectomy. Numerous postoperative symptoms and a possible correlation of the procedure with a higher incidence of right-sided colon carcinoma have been described. Therefore, it has been suggested to remove the gallstones via a cholecystotomy, leaving the gallbladder in place. This is the first report on the functional and symptomatic outcome of laparoscopic cholecystotomy (LCO) versus LCE in a consecutive series of children. A follow-up study of all children who underwent surgery for symptomatic gallstone disease from 1993 to 1999 was performed. Nine underwent LCO and 8 standard LCE. The procedure was chosen according to the preference of the surgeon. Patients and parents underwent a standardized follow-up interview. The intensitiy of six gastrointestinal symptoms was graded from 0 to 3. The patients and parents scored the symptomatic outcome using a 100-point visual analogue scale. There were no intraoperative complications. Bleeding of a port site required suturing in 1 patient after LCO, and fever with a further uneventful course occurred in another after LCE. The mean duration of hospital stay was 3.0 days after LCO and 2.4 days after LCE. In 1 patient a missed gallstone was identified 4 weeks after LCO. The patient underwent LCE with a further uneventful course. At follow-up (mean 20.7 months after LCO, 28.3 months after LCE, P = n.s.) there was a tendency toward a lower incidence of symptoms after LCO. Symptoms were reported by 3 of 8 patients after LCO and 5 of 8 after LCE. The mean score of the symptomatic outcome was not statistically different. All patients with LCO were free of stones on ultrasound examination with normal contraction of the gallbladder. LCO thus represents an alternative approach. We consider LCO for children with symptomatic cholecystolithiasis before the onset of puberty. However, data on the long-term outcome from larger series are mandatory before a general recommendation can be given.