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Published on: February 28, 2025
Two-Incision Laparoscopic Cholecystectomy in Children
Sarah W Lai1,2, Steven S Rothenberg2, Kristin E Shipman2
11 Alberta Children's Hospital , Calgary, Alberta, Canada .
Insights
Two-incision laparoscopic cholecystectomy (2I-LC) is a safe alternative for pediatric gallbladder disease, comparable to four-port laparoscopic cholecystectomy (4P-LC). Overweight children may require additional ports during 2I-LC.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Gastrointestinal surgery
Background:
- Laparoscopic cholecystectomy is standard for pediatric gallbladder disease.
- Minimally invasive techniques aim to reduce scarring and improve cosmesis.
- Two-incision laparoscopic cholecystectomy (2I-LC) offers a potentially less invasive approach compared to traditional four-port laparoscopic cholecystectomy (4P-LC).
Purpose of the Study:
- To evaluate the safety and efficacy of 2I-LC in pediatric patients.
- To compare the outcomes of 2I-LC with 4P-LC in children and adolescents (≤21 years).
Main Methods:
- Retrospective review of 389 pediatric patients undergoing 2I-LC or 4P-LC between 2010 and 2016.
- 2I-LC utilizes two 5-mm ports and a 2-mm grasper within a single umbilical incision, plus a 3-mm subxiphoid port.
- Comparison of demographic, operative, and outcome data between the two groups using statistical tests.
Main Results:
- 2I-LC was performed in 72% of cases, with 4P-LC in 19%.
- Higher Body Mass Index (BMI) was noted in the 4P-LC group.
- Operative times were longer for 4P-LC. Conversion rates from 2I-LC to 4P-LC were 2.4%, associated with higher BMI and operative time.
Conclusions:
- 2I-LC is a safe and viable alternative for pediatric gallbladder disease, facilitating critical view of the anatomy.
- Longer operative times in 4P-LC may be due to patient selection bias (higher BMI, complex gallstone disease).
- Increased BMI is a predictor for requiring additional ports during 2I-LC.
Purpose:
To evaluate two-incision laparoscopic cholecystectomy (2I-LC) in children, and compare outcomes with four-port laparoscopic cholecystectomy (4P-LC).
Methods:
A retrospective review was performed on children (≤21 years) with gallbladder disease treated with 2I-LC or 4P-LC between February 2010 and February 2016. 2I-LC is performed using two 5-mm ports and a 2-mm endoscopic grasper within a 12-mm umbilical incision, and a 3-mm subxiphoid port for dissection. Demographic, diagnostic, operative, and outcome data were recorded, and the two groups were compared with chi-squared, Fisher, and t-tests. Patients requiring conversion from 2I-LC to 4P-LC were examined to determine factors predicting the need for additional ports.
Results:
Three hundred eighty-nine laparoscopic cholecystectomies were performed (2I-LC 72.0%, 4P-LC 19.0%). Body mass index (BMI) was greater in the 4P-LC group. 2I-LC was more commonly performed for biliary dyskinesia, but not biliary colic, acute cholecystitis, choledocholithiasis, and gallstone pancreatitis. Operative time was greater in 4P-LC. There were 6 wound infections (2I-LC 1.8%, 4P-LC 1.5%), 1 common bile duct injury (2I-LC 0.4%, 4P-LC 0.0%), and 1 small bowel injury (2I-LC 0.0%, 4P-LC 1.5%). 2.4% of 2I-LC required conversion to 4P-LC, with BMI and operative time greater than the 2I-LC group, but not different from 4P-LC with no complications.
Conclusions:
2I-LC is a safe alternative to 4P-LC for pediatric gallbladder disease, allowing for traction and countertraction to expose the critical view. Operative time was longer in the 4P-LC group, likely secondary to selection bias with higher BMI and preoperative diagnosis of gallstone disease. Overweight patients are more likely to require additional ports.
