Laparoscopic cholecystectomy in infants and children: modifications and cost analysis

Between June 1990 and February 1993, 26 children underwent laparoscopic cholecystectomy. Their ages ranged from 25 months to 19 years (mean, 12.3 years; median, 13 years). Only six of them had hemolytic diseases associated with gallstones. Five presented with acute cholecystitis. Laparoscopic cholecystectomy was performed on these five, within 5 days of admission; the mean postoperative hospital stay was 2.5 days. The other 21 patients underwent elective cholecystectomy; their mean postoperative stay was 1 day. Several modifications have been made in our technique. Three 5-mm ports and one 10-mm umbilical port are used. In addition, direct incision of the umbilical fascia is performed with insertion of a blunt trocar and cannula rather than using the Veress needle for insufflation. The importance of positioning the epigastric cannula in the left upper quadrant in small children cannot be overemphasized. Cholangiography is now attempted in all patients and is easier with the Kumar cholangioclamp and sclerotherapy needle, under fluoroscopy. The total hospital charges for the patients who underwent elective laparoscopic cholecystectomy are compared retrospectively with those of seven children who had elective open cholecystectomy during the same period. In addition, a comparison is made between the two groups with respect to the costs of operating room equipment and postoperative pain control.