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Published on: September 13, 2022
Cholelithiasis management in a third-level pediatric center: case series and literature review
M C Y Wong1, F Incerti2,3, S Avanzini2
1Pediatric Surgery, IRCCS, Istituto Giannina Gaslini, 16147, Genoa, Italy. michela.wong1987@gmail.com.
Insights
Pediatric cholelithiasis (gallstones in children) is increasingly diagnosed. Laparoscopic cholecystectomy is a safe and effective treatment for children over 10, especially those with comorbidities.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Abdominal Imaging
Background:
- Pediatric cholelithiasis diagnosis is rising due to increased ultrasonography use, pediatric obesity, and prolonged parenteral nutrition.
- Clinical presentations vary, and complicated onsets can lead to severe outcomes.
Purpose of the Study:
- To report a 15-year experience in treating pediatric cholelithiasis at a specialized pediatric center.
- To analyze demographic data, clinical presentations, risk factors, surgical outcomes, and complications.
Main Methods:
- Retrospective study of children with gallstones operated on between 2006 and 2020.
- Evaluation of patient demographics, clinical findings, sonographic results, comorbidities, surgical procedures, and follow-up data.
- Inclusion of 199 pediatric patients diagnosed with cholelithiasis.
Main Results:
- 14.5% of patients experienced a complicated onset of cholelithiasis.
- Children over 10 years old had a higher incidence of symptomatic or complicated presentations.
- Hemolytic disease was the most common comorbidity (16.1%).
- Laparoscopic cholecystectomy was performed in 96.5% of cases with a low conversion rate (1.6%).
- Major postoperative complications occurred in less than 1% of patients.
Conclusions:
- Laparoscopic cholecystectomy is a safe and effective treatment for pediatric cholelithiasis in patients over 10 years, particularly those with comorbidities.
- Simultaneous laparoscopic splenectomy can be safely performed when indicated.
- Establishing pediatric surgical timing guidelines for cholelithiasis warrants further investigation.
Abstract:
Pediatric cholelithiasis is being increasingly diagnosed owing to the widespread use of ultrasonography, raised pediatric obesity and use of long-time parenteral nutrition. Clinical presentation is variable and complicated onset could lead to severe consequences. The aim of this study is to present a 15-years-experience of a pediatric third-level-center in treating cholelithiasis. A retrospective study collecting children with gallstone operated on between 2006 and 2020 is presented. Demographic data, clinical presentation, sonographic findings, risk factors, surgery, complications, follow-up were evaluated. 199 patients were included. Twenty-nine patients (14.5%) with cholelithiasis had a complicated onset. Patients with cholelithiasis older than 10 years had a higher rate of symptomatic/complicated onset. Hemolytic disease was the most frequent co-morbidity (16.1%). Laparoscopic cholecystectomy was performed in 192 cases (96.5%) with a conversion rate of 1.6%. Nearly 1% showed a major post-operative complication after cholecystectomy. Cholelithiasis in patients older than 10 years can be safely treated with laparoscopic cholecystectomy, especially if one or more co-morbidities are present. Laparoscopic splenectomy can be easily associated in the same procedure depending on medical indication. Definition of pediatric surgical timing guidelines would be of quite interest in the field.
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