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Medium-term results after cholecystectomy in patients younger than 10 years
G Mattioli1, P Repetto, C Carlini
1Pediatric Surgical Unit, Giannina Gaslini Research Institute, University of Genova,School of Pediatric Surgery, Largo G. Gaslini 5, 16100 Genova, Italy. girolamomattioli@ospedale-gaslini.ge.it
Insights
Laparoscopic cholecystectomy is a safe and effective treatment for gallbladder stones in children under 10. This minimally invasive approach offers outcomes comparable to open surgery with minimal complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Gallbladder stones (cholelithiasis) are a significant pediatric concern, often linked to hematological disorders.
- Idiopathic cholelithiasis is increasing in children, accounting for 50% of cases.
- Laparoscopic cholecystectomy is explored in children under 10 years.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic cholecystectomy in children younger than 10 years.
- To compare outcomes of laparoscopic cholecystectomy with traditional open surgery in pediatric patients.
- To assess the feasibility of laparoscopy in children with a history of abdominal surgery.
Main Methods:
- A prospective study involving 58 pediatric patients (<10 years) who underwent laparoscopic cholecystectomy between 1992 and 1999.
- Patients had prior conservative treatment for at least 12 months and were stone migration-free for 6 months.
- Comprehensive follow-up included clinical assessments and ultrasounds at 1, 12, and 36 months post-surgery.
Main Results:
- Mean operative time was 63 minutes for cholecystectomy alone and 150 minutes with splenectomy.
- No major complications or reoperations occurred; minor complications included bleeding and omental insufflation.
- One conversion to open surgery was necessary due to technical issues; overall follow-up showed no complications.
Conclusions:
- Laparoscopic cholecystectomy is deemed the gold standard for pediatric gallbladder stone removal.
- The complication rate is comparable to open cholecystectomy, with equivalent patient follow-up.
- Prior abdominal surgery does not contraindicate the laparoscopic approach in children.
Background:
Gallbladder stones are a well-known and widely studied problem in children. Hematological disorders are the most common diseases that can cause cholelithiasis. However, in the last few years, the proportion of children with idiopathic cholelithiasis has increased 50%. Herein, we present a prospective study on laparoscopic cholecystectomy in a selected group of patients aged < 10 years.
Methods:
Fifty-eight patients aged < 10 years underwent laparoscopic cholecystectomy for stones in the period 1992-99. The female/male ratio was 1.5, the mean age was 8 years (range, 2-10), and the mean weight was 30 kg. In all patients, parenteral nutrition, fasting state, and prolonged use of antibiotics had been suspended for > or = 6 months, and conservative treatment had been tried for > or = 12 months in the absence of symptoms of stone migration. All the patients were followed up after surgery: clinically at 1,6,12, and 36 months and by ultrasound at 1, 12, and 36 months. Liver function and hematological tests were performed in case of symptoms or if hemolytic disorders were the cause of stones.
Results:
The mean operative time was 63 min (range, 30-120) in children undergoing cholecystectomy alone and 150 min in children undergoing associated splenectomy. There were no major complications or reoperations. Minor complications included bleeding from accessory cystic artery (n = 3) and insufflation of the omentum (n = 2). One case was converted to an open procedure due to technical problems. All the children were followed up and no complications were observed.
Conclusion:
We consider the laparoscopic approach the gold standard for cholecystectomy in children. This procedure does not have a complication rate any higher than open cholecystectomy, and patient follow-up is as good as that of open surgery. Previous abdominal surgery is not a contraindication to laparoscopy.