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Management of Cholelithiasis in Children With Associated Diseases: Should Prophylactic Cholecystectomy Be
Alessandro Boscarelli1, Manuela Giangreco2, Daniela Codrich1
1Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy.
Insights
Pediatric cholelithiasis (gallstones) management is unclear for asymptomatic cases. Early prophylactic cholecystectomy (gallbladder removal) in children with conditions like cystic fibrosis may reduce hospital stays and surgical risks.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Management
Background:
- Cholelithiasis incidence is rising in children, yet no guidelines exist for asymptomatic cases with predisposing conditions.
- Predisposing conditions include hematologic diseases and cystic fibrosis, increasing pediatric gallstone risk.
Purpose of the Study:
- To evaluate the potential benefits of prophylactic cholecystectomy in pediatric patients with asymptomatic cholelithiasis and predisposing conditions.
- To identify specific patient groups that may benefit from early surgical intervention.
Main Methods:
- Retrospective review of medical records for children undergoing elective laparoscopic cholecystectomy from October 2011 to September 2022.
- Categorization of 32 patients into five groups based on associated pathologies.
Main Results:
- 81.25% of patients were symptomatic, while 18.75% were asymptomatic at presentation.
- Asymptomatic pediatric patients with hematologic diseases or cystic fibrosis had shorter hospital stays following prophylactic cholecystectomy compared to those who became symptomatic.
Conclusions:
- Early prophylactic laparoscopic cholecystectomy may be beneficial for pediatric patients with asymptomatic cholelithiasis and associated conditions, particularly hematologic diseases and cystic fibrosis.
- This approach could potentially decrease surgical complications and shorten hospital stays.
Abstract:
Cholelithiasis is increasing in the pediatric population, and there are currently no guidelines for the management of asymptomatic patients with both cholelithiasis and a predisposing condition. This study seeks to highlight situations where prophylactic cholecystectomy may be desirable. We retrospectively reviewed the medical records of children who underwent elective laparoscopic cholecystectomy between October 2011 and September 2022. Thirty-two patients were included in the study. Five different groups of patients were identified based on associated pathologies. Twenty-six patients were symptomatic (81.25%), and six were asymptomatic (18.75%). All patients underwent a laparoscopic cholecystectomy. Hematologic and cystic fibrosis patients with asymptomatic cholelithiasis had a shorter length of hospital stay than patients with the same condition who progressed from asymptomatic to symptomatic gallstone disease. Consequently, patients with associated diseases (particularly hematologic diseases and cystic fibrosis) may benefit from early laparoscopic cholecystectomy, which could reduce the probability of surgical difficulties and shorten the length of hospital stay.
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