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Published on: September 13, 2022
[Cholecystolithotomy: first middle-long term results of our series]
J L Roqués1, R Ruiz Pruneda, J Sánchez
1Hospital Universitario Virgen de la Arrixaca, Murcia.
Insights
Cholecystotomy is a safe and effective procedure for pediatric gallstones, showing no complications or relapses in long-term follow-up. This treatment is ideal for children with specific types of uncomplicated gallstones.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Biliary tract disease
Context:
- Cholelithiasis (gallstones) in children is increasingly common and presents differently than in adults.
- Laparoscopic cholecystectomy, the standard treatment, carries potential risks, leading to exploration of alternative methods.
- Cholecystotomy is a less common but potentially viable option for pediatric gallstone management.
Purpose:
- To evaluate the safety, efficacy, and long-term outcomes of cholecystotomy in pediatric patients with cholelithiasis.
- To present the authors' specific criteria for indicating cholecystotomy in children.
- To assess the complication and relapse rates of cholecystotomy over a mean follow-up of 10 years.
Summary:
- A prospective study followed 16 pediatric patients undergoing cholecystotomy for gallstones.
- The procedure demonstrated a high success rate, with 11 of 16 patients remaining asymptomatic with normal tests at long-term follow-up.
- One patient experienced a possible relapse, and another had persistent abdominal pain despite normal tests; two were lost to follow-up.
Impact:
- Cholecystotomy appears to be a complication-free, safe, and straightforward procedure for select pediatric patients with gallstones.
- The technique shows a very low long-term relapse rate, making it a potentially valuable alternative to cholecystectomy.
- Further research may solidify cholecystotomy's role in managing specific cases of pediatric cholelithiasis.
Unlabelled:
Cholelithiasis in children is an infrequent disease whose incidence has increased over the last few decades. It has its own typical characteristics, different from those present in adults. Laparoscopic cholecystectomy has become the treatment of choice for symptomatic cases, still its connection with right-sided colon cancer and other diseases associated with the procedure has led to recommend it with some reservation. Though several authors adopted cholecystotomy as a therapeutic option in recent years, its use remains controversial. Our indication criteria for this technique are presented herewith, as well as long- and medium-term results (mean follow-up of 10 years) of our series, previously reported in 2003, and a new case added later in 2006.
Materials And Methods:
Since 2003, a prospective study of 15 patients from our previous series and a new patient added afterwards is being carried out, including: 1) Medical history checking for symptoms connected with biliary conditions. 2) DIAGNOSTIC TESTS: laboratory tests and ultrasonography.
Results:
Out of our 16 patients: A girl relapsed a few months later and underwent cholecystectomy, but whether it was a true relapse or a missed gallstone was not established. A patient with a history of recurrent abdominal pain has shown no improvement in his symptoms even though his tests are normal. Two patients have been lost for our study, but showed normal tests for 5 and 7 years respectively. Our 11 remaining patients show no symptoms as well as normal laboratory and imaging tests. A new patient joined our study in 2006, showing normal tests to date and no postsurgical complications.
Conclusions:
Based on our experience, cholecystotomy has proved to be a complication-free, safe and easy procedure with a virtually nonexistent relapse rate in the long and medium term for patients in the pediatric age group presenting with single or double cholelithiasis, unchanged for 1-2 years with no size increase, no apparent etiology, no complications and a normal bile duct.
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