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Complications in pediatric laparoscopic cholecystectomy: systematic review
Karina Miura da Costa1,2, Amulya Kumar Saxena3
1Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK.
Insights
Laparoscopic cholecystectomy (LC) is a safe procedure for children, with low complication rates. Most issues are minor, but nearly one-fifth require intervention, primarily for bleeding and biliary tree problems.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy (LC) is the standard surgical approach for symptomatic children.
- While generally safe, potential complications like bile duct injury are a concern.
Purpose of the Study:
- To review and analyze the complications associated with LC in pediatric patients.
- To identify the types, frequency, and management of complications in pediatric LC.
Main Methods:
- A systematic review of studies on LC in patients aged 18 years or younger.
- Databases searched included MEDLINE/PubMed, CENTRAL, and Lilacs.
- Data extraction focused on patient demographics, surgical details, complications, mortality, and follow-up.
Main Results:
- A total of 2783 patients from 24 studies were analyzed.
- The overall complication rate was 3.3% (93 patients), with wound issues, perforations, and bleeding being most common.
- Biliary tree complications occurred in 9 patients, with 6 involving the common bile duct; 18.3% of complications required re-intervention.
Conclusions:
- Laparoscopic cholecystectomy is a safe procedure in children with a low overall complication rate.
- While most complications are minor, a significant proportion necessitate intervention, particularly those involving bleeding and the biliary tree.
- No mortality was reported in pediatric LC cases.
Abstract:
Laparoscopic cholecystectomy (LC) is the gold standard for surgical management in symptomatic children, but it is not without complications, bile duct injury being among the most feared. This study reviewed the complications of LC in children. MEDLINE/PubMed, CENTRAL and Lilacs were reviewed for LC. Studies in patients ≤ 18 years of age published in English, Portuguese or Spanish were selected by two independent reviewers. Data were collected for patients' characteristics, surgical information, complications, mortality and follow-up. Twenty-four papers were identified and offered 2783 patients. Mean age was 11 years (3 months-18 years). In the 93/2783 (3.3%) complications, single-port procedures were associated with seven (7.5%), 3/4-port with 81 (87.1%) and the number of ports were not specified in five. Routine cholangiography was not part of the protocol in any of the reports. Complications included wound issues (n = 24), perforation (n = 14), bleeds (n = 13), biliary tree complications (n = 9), sickle cell crisis (n = 8), fever (n = 6), leaks (n = 4), pain (n = 3), nausea/emesis (n = 3) and others (n = 9). Two of these patients had a history of obesity and cholecystitis and only two biliary tree lesions were diagnosed intra-operatively. Seventeen cases (18.3%) required re-intervention: 15 surgical and two endoscopic. Issues related to biliary tree included: common bile duct lesion (n = 6), biliary fistula (n = 3), clip dislocation from cystic duct (n = 1), cholangitis (n = 1) and calculus (n = 1). There was no mortality, and the mean follow-up period was 10.3 months (1 month-5 years). LC is safe in children and, although most complications are minor, almost 1/5 complications require interventions, mostly due to bleeding and biliary tree complications. Mortality has not been reported in pediatric LC.
