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Published on: September 13, 2022
Cholelithiasis in childhood: a follow-up study
J F Robertson1, R Carachi, E M Sweet
1Department of Paediatric Surgery, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland.
Insights
Cholelithiasis (gallstones) in children can be treated with cholecystostomy and gallstone removal, offering an alternative to cholecystectomy. This approach is effective, even for asymptomatic cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Cholelithiasis, or gallstones, is a condition affecting children, with varied causes including idiopathic and hereditary factors.
- Hereditary spherocytosis is a known risk factor for gallstone formation in pediatric patients.
- Long-term follow-up is crucial for assessing outcomes in pediatric gallstone disease.
Purpose of the Study:
- To review the management and outcomes of pediatric cholelithiasis treated between 1973 and 1985.
- To evaluate the efficacy of different surgical interventions for pediatric gallstones.
- To compare cholecystostomy with cholecystectomy in children with gallstones.
Main Methods:
- Retrospective review of 15 pediatric patients with cholelithiasis.
- Analysis of treatment modalities including cholecystostomy, cholecystectomy, and choledochotomy.
- Follow-up assessments including clinical review and ultrasonography.
Main Results:
- Ten patients had idiopathic gallstones; five had gallstones associated with hereditary spherocytosis.
- Only seven of the 14 surgically treated patients were symptomatic.
- Cholecystostomy with gallstone removal demonstrated acceptable outcomes, comparable to cholecystectomy.
Conclusions:
- Cholelithiasis in children can present with or without symptoms.
- Cholecystostomy with gallstone removal is a viable alternative surgical option for pediatric gallstones.
- Asymptomatic gallstones may not require immediate surgical intervention.
Abstract:
Fifteen children with cholelithiasis who were treated at the Royal Hospital for Sick Children, Glasgow between 1973 and 1985 are reviewed. Ten patients had idiopathic gallstones and five had gallstones in association with hereditary spherocytosis. All patients have been followed up for between 4 months and 12 years (mean 4.1 years): ultrasonography has been carried out on 13. Fourteen patients underwent surgery of whom only seven had symptoms from their gallstones. Nine patients had cholecystostomy and removal of gallstones, four patients had cholecystectomy (one had negative exploration of the common bile duct in addition) and one patient with choledocholithiasis underwent choledochotomy with transduodenal sphincterotomy. One patient did not have surgery; she has remained asymptomatic and ultrasound examination confirms that she still has a solitary gallstone in her gallbladder. Clinical review with ultrasonography shows that cholecystostomy with removal of gallstones appears to be an acceptable alternative to cholecystectomy.
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