Laparoscopic cholecystectomy in infants and children: modifications and cost analysis
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Published on: March 28, 2025
G W Holcomb1, K W Sharp, W W Neblett
1Department of Pediatric Surgery, Children's Hospital, Nashville, TN.
Insights
Laparoscopic cholecystectomy in children offers a shorter hospital stay, especially for elective procedures. This minimally invasive approach is effective for treating gallstones and acute cholecystitis in pediatric patients.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Gallstones in children are uncommon but can lead to acute cholecystitis.
- Laparoscopic cholecystectomy is a standard procedure in adults, but its application in pediatric populations requires specific considerations.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic cholecystectomy in pediatric patients.
- To compare the outcomes, including hospital stay and costs, of laparoscopic versus open cholecystectomy in children.
Main Methods:
- Retrospective review of 26 children undergoing laparoscopic cholecystectomy between June 1990 and February 1993.
- Comparison of outcomes with seven children who underwent open cholecystectomy during the same period.
- Detailed description of surgical technique modifications for pediatric laparoscopic cholecystectomy, including port placement and insufflation methods.
Main Results:
- Mean age of patients was 12.3 years, with a range from 25 months to 19 years.
- Postoperative hospital stay was significantly shorter for elective laparoscopic cholecystectomy (1 day) compared to acute cases (2.5 days).
- Initial comparisons suggest potential cost-effectiveness for laparoscopic procedures regarding operating room equipment and postoperative pain management.
Conclusions:
- Laparoscopic cholecystectomy is a viable and effective surgical option for pediatric patients with gallstones and associated conditions.
- Specific technical modifications are crucial for successful pediatric laparoscopic cholecystectomy.
- Further studies are warranted to confirm the cost-effectiveness and long-term outcomes compared to open procedures.
Abstract:
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.
