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Management of cholelithiasis in Italian children: a national multicenter study
Claudia Della Corte1, Diego Falchetti, Gabriella Nebbia
1Pediatric Liver Unit, Department of Pediatrics, University Federico II of Naples, Via S. Pansini 5, Naples 80131, Italy.
Insights
Pediatric gallstone management in Italy varied. Ursodeoxycholic acid improved symptoms but not stone dissolution, while laparoscopic cholecystectomy proved safe and effective for children with cholelithiasis.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Pediatric Surgery
Background:
- Cholelithiasis (gallstones) in children is increasingly diagnosed.
- Management strategies for pediatric gallstones lack standardization.
Purpose of the Study:
- To evaluate current management approaches for pediatric cholelithiasis in Italy.
- To assess the efficacy and safety of different treatment modalities.
Main Methods:
- Retrospective analysis of 180 children diagnosed with cholelithiasis.
- Data collected via anonymous questionnaire from participating centers.
- Review of treatments including ursodeoxycholic acid, cholecystectomy, and observation.
Main Results:
- Ursodeoxycholic acid (UDCA) treated 117 children; 8 achieved dissolution, with 3 recurrences. 65% of symptomatic children improved.
- Cholecystectomy performed on 64 children, with only 2 postoperative complications.
- 34 children received no treatment and showed no complications during follow-up.
Conclusions:
- Therapeutic strategies for pediatric gallstones are highly heterogeneous.
- UDCA is ineffective for gallstone dissolution but can alleviate symptoms.
- Laparoscopic cholecystectomy is a safe and effective treatment for pediatric gallstones.
Aim:
To evaluate the management of Italian children with cholelithiasis observed at Pediatric and Surgical Departments linked to Italian Society of Pediatric Gastroenterology Hepatology and Nutrition.
Methods:
One-hundred-eighty children (90 males, median age at diagnosis 7.3 years; range, 0-18 years) with echographic evidence of cholelithiasis were enrolled in the study; the data were collected by an anonymous questionnaire sent to participating centers.
Results:
One hundred seventeen patients were treated with ursodeoxycholic acid; in 8 children dissolution of gallstones was observed, but the cholelithiasis recurred in 3 of them. Sixty-five percent of symptomatic children treated became asymptomatic. Sixty-four patients were treated with cholecystectomy and in only 2 cases a postoperative complication was reported. Thirty-four children received no treatment and were followed with clinical and echographic controls; in no case the development of complications was reported.
Conclusion:
The therapeutic strategies were extremely heterogeneous. Ursodeoxycholic acid was ineffective in dissolution of gallstones but it had a positive effect on the symptoms. Laparoscopic cholecystectomy was confirmed to be an efficacy and safe treatment for pediatric gallstones.
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