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Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing
Gloria Pelizzo1, Rossana Bussani2, Annalisa De Silvestri3
1Pediatric Surgery Unit, V. Buzzi Children's Hospital and Department of Biomedical and Clinical Science L. Sacco, University of Milano, Milan, Italy.
Insights
Determining the optimal timing for laparoscopic cholecystectomy in children with symptomatic gallbladder disease requires a dedicated scoring system. Adult criteria are insufficient for assessing gallbladder damage severity in pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Laparoscopic cholecystectomy (LC) is the standard treatment for gallbladder pathologies.
- Symptomatic cholecystic disease (SCD) in children necessitates careful evaluation for surgical intervention.
- Existing criteria for assessing gallbladder disease severity in adults are not directly applicable to pediatric cases.
Purpose of the Study:
- To evaluate clinical, ultrasonographic (US), and histopathological findings in children undergoing LC.
- To define appropriate surgical timing for pediatric patients with symptomatic gallbladder disease.
- To develop a dedicated scoring system for assessing gallbladder damage severity in children.
Main Methods:
- Retrospective review of pediatric patients who underwent elective LC (ELC) or urgent LC (ULC).
- Analysis of clinical, US, surgical, and histopathological data.
- Development and application of clinical, operative, and histopathological risk scores.
Main Results:
- No significant differences in US signs were observed between ELC and ULC groups.
- Histopathological findings of fibrosis and atrophy were present in both ELC and ULC groups.
- Higher clinical risk scores were associated with ELC, and specific factors (inflammatory signs, lithotherapy, wall thickening) increased operative and histopathological risk scores.
Conclusions:
- Adult criteria are inadequate for determining gallbladder damage severity in children.
- A specialized clinical and US-based scoring system is essential for guiding surgical timing in pediatric SCD.
- Accurate assessment is crucial for optimizing outcomes in pediatric laparoscopic cholecystectomy.
Abstract:
Background: Laparoscopic cholecystectomy (LC) is the standard of care for gallbladder (GB) pathologies. We evaluated clinical, ultrasonographic (US) data as well as histopathological findings in children affected with symptomatic cholecystic disease (SCD) who underwent LC, with the aim of defining surgical timing. Methods: We reviewed our cases who underwent elective LC (ELC) or urgent LC (ULC). Clinical, US, surgical and histological features were used to create different risk scores. Results: We considered 26 children (17 ELC/9 ULC). US signs were not different in the two groups (p > 0.05). Operating times were longer in ELC than in ULC (p = 0.01). Histopathological evaluation revealed fibrosis and atrophy in both ELC and ULC. The clinical risk score was higher in ELC compared to ULC (p < 0.001). An increased operative risk score was noted in patients with systemic inflammatory signs (OR1.98), lithotherapy (OR1.4.3) and wall thickening ≥3 mm (OR2.6). An increased histopathological risk score was detected in children with symptom duration >7 days (OR3.61), concomitant hematological disease (OR1.23) and lithotherapy (OR3.61). Conclusion: Criteria adopted in adults cannot be adopted to detect the severity of GB damage in children. A dedicated clinical and US score is mandatory to define the most appropriate surgical timing.
