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Published on: February 28, 2025
Laparoscopic cholecystectomy in the pediatric population
Shawn D St Peter1, Scott J Keckler, Abhilash Nair
1Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA.
Insights
Laparoscopic cholecystectomy is a safe and effective procedure for children, with biliary dyskinesia increasingly diagnosed and responding well to surgery. This approach minimizes complications in pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy in pediatric patients is less common and underreported compared to adults.
- This study reviews the experience with this surgical approach in a pediatric hospital.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic cholecystectomy in children.
- To analyze the indications, outcomes, and complications of the procedure in a pediatric population.
Main Methods:
- Retrospective review of 224 pediatric patients undergoing laparoscopic cholecystectomy between 2000 and 2006.
- Data collected included patient demographics, surgical indications, operative time, and complications.
Main Results:
- Symptomatic gallstones and biliary dyskinesia were the most common indications.
- The mean operative time was 77 minutes with no conversions, ductal injuries, bile leaks, or mortality.
- Biliary dyskinesia diagnosis increased over time, with patients showing symptom improvement post-surgery.
Conclusions:
- Laparoscopic cholecystectomy is a safe and effective treatment for pediatric patients.
- Biliary dyskinesia is a significant indication in children, responding well to cholecystectomy.
- Pediatric patients present with less complicated gallstone disease, leading to fewer ductal complications.
Background:
The experience with laparoscopic cholecystectomy in children trails the adult numbers and remains underreported. Therefore, we reviewed our experience with this approach.
Methods:
A retrospective review of our most recent 6-year experience with laparoscopic cholecystectomy at Children's Mercy Hospital (Kansas City, MO) between September 5, 2000, and June 1, 2006, was performed. Data points reviewed included patient demographics, indication for operation, operative time, complications, and recovery.
Results:
During the study period, 224 patients underwent a laparoscopic cholecystectomy. The mean age was 12.9 years (range, 0-21) with a mean weight of 58.3 kg (range, 3-121). Indications for laparoscopic cholecystectomy were symptomatic gallstones in 166 children, biliary dyskinesia in 35, gallstone pancreatitis in 7, gallstones and an indication for splenectomy in 6, calculous cholecystitis in 5, choledocholithiasis in 1, gallbladder polyps in 1, acalculous cholecystitis in 1, and congenital cystic duct obstruction in 1. The mean operative time (excluding patients with concomitant operations) was 77 minutes (range, 30-285). An intraoperative cholangiogram was performed in 38 patients. Common bile duct (CBD) stones were cleared intraoperatively in 5 patients. Two patients required a postoperative endoscopy to retrieve CBD stones. One sickle-cell patient developed a postoperative hemorrhage, requiring a laparotomy. There were no conversions, ductal injuries, bile leaks, or mortality. Biliary dyskinesia was diagnosed in 10% of the first 30 patients in this series and 40% of the most recent 30 patients. The mean ejection fraction in these patients was 21%. All experienced an improvement in their symptoms after the cholecystectomy.
Conclusions:
Laparoscopic cholecystectomy is safe and effective in children. Biliary dyskinesia is becoming more frequently diagnosed in children, and these patients respond favorably to cholecystectomy. As opposed to the adult population, the incidence of complicated gallstone disease appears less common in children, as most present with symptomatic cholelithiasis without active inflammation, accounting for the very low rate of ductal complications.
