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[Must we change the surgical treatment of gallstones?]
J Elías Pollina1, R Delgado Alvira, N González Martínez-Pardo
1Servicio de Cirugía Pediátrica, Hospital Infantil Universitario Miguel Servet, Zaragoza. jelias@salud.aragon.es
Insights
Childhood gallstones are increasing. This study suggests conservative management for asymptomatic cases and specific surgical approaches for symptomatic children, with cholecystolithotomy as a preferred option for solitary stones.
Area of Science:
- Pediatric Gastroenterology
- Surgical Innovation
- Gallstone Disease Management
Context:
- Childhood gallstone incidence is rising, possibly due to increased diagnosis via ultrasound.
- Predisposing factors identified in some pediatric cases.
- Gallstone presentation varies from asymptomatic to acute cholecystitis.
Purpose:
- To determine the optimal treatment strategy for pediatric gallstone patients.
- To evaluate the effectiveness of different management approaches.
- To identify the best surgical option based on clinical presentation.
Summary:
- A retrospective study analyzed 71 children with gallstones over 20 years.
- Spontaneous resolution occurred in two cases; ursodeoxycholic acid was largely ineffective.
- Surgical interventions included laparoscopic cholecystectomy, open cholecystectomy, and cholecystolithotomy.
Impact:
- Recommends conservative management for asymptomatic children with periodic ultrasound monitoring.
- Highlights cholecystolithotomy as the surgical choice for solitary gallstones without gallbladder inflammation.
- Suggests laparoscopic cholecystectomy for non-functional or porcelain gallbladders and in patients with hematologic conditions.
Unlabelled:
The incidence of gallstones in childhood is 0.15%-0.22%. Frequency has increased in recent years due to a real increase or to a better diagnosis by ultrasound. The aim of our study is determinate the best treatment for every patient.
Materials And Methods:
A retrospective study of 71 children with cholelithiasis admitted to our hospital in the last 20 years.
Results:
The male to female ratio was 43:28. Seventeen patients present predisposing factors that might be related to the formation of gallstones. This disease was a casual event in half the cases. In 24 patients the diagnosis was made during a study for inspecific abdominal pain and 14 children showed typical symptoms. Only one patient suffer from acute cholecystitis. In 21 cases we find a single stone and in the other cases there were a lot of stones. The gallstones disappeared spontaneously in two patients. Nine children received treatment with ursodeoxycholic acid, but this treatment was ineffective in 8 of them. 27 patients were operated: Six laparoscopic cholecystectomy, 9 open cholecystectomy, 9 cholecystolithotomy and 3 cholecystectomy with splenectomy.
Conclusions:
We recommend periodic checks with ultrasound and conservative management is suggested in asymptomatic children. Operative intervention is recommended for symptomatic patients. The surgical treatment of choice in our centre for patients with solitary gallstones and without inflammatory changes in the gallbladder is cholecystolithotomy. We didn't find reappearence of gallbladder after cholecystolithotomy. Laparoscopic cholecystectomy is the best treatment for children with non working gallbladder, "porcelain gallbladder" and in patients with haematologic disease and gallstones.
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