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Bacteriology of cholelithiasis in infants and children
1Department of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
Insights
Laparoscopic cholecystectomy in children rarely shows positive bile cultures, suggesting routine antibiotics may not be needed. Intraoperative bile spillage also had no adverse effects.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Infectious Disease
Background:
- Laparoscopic cholecystectomy is increasingly the standard for symptomatic gallstones in children.
- Current practices for perioperative antibiotics and managing bile leaks require evaluation.
Purpose of the Study:
- To establish routine policies for perioperative antibiotics.
- To determine the management of biliary leaks in pediatric laparoscopic cholecystectomy.
Main Methods:
- Review of bile cultures and postoperative outcomes for 30 pediatric patients.
- Analysis of cases with intraoperative bile spillage.
Main Results:
- Only one child (3.3%) had a positive bile culture (Salmonella Group D).
- All 30 patients, including six with bile spillage, had uneventful postoperative courses.
- Intraoperative bile spillage was clinically insignificant.
Conclusions:
- Routine preoperative antibiotic use in pediatric laparoscopic cholecystectomy may be unnecessary.
- Intraoperative bile spillage can be managed effectively with saline irrigation.
Abstract:
Today, laparoscopic cholecystectomy is rapidly replacing traditional cholecystectomy as the standard treatment of symptomatic cholelithiasis in children. We reviewed the bile cultures and postoperative course of 30 children who underwent laparoscopic cholecystectomy with the aim of establishing a routine policy for perioperative antibiotic treatment and for the management of biliary leak during that procedure. A positive bile culture was found in only one child (Salmonella Group D). All patients, including six children with intraoperative bile spillage, had a completely normal and uneventful postoperative course. We concluded that the use of preoperative antibiotic treatment should be limited in laparoscopic cholecystectomy in children and is probably not required at all, awaiting proof from a further study. The present study further showed that intraoperative bile spillage is of no clinical significance and can be treated simply with local saline irrigation during the laparoscopic procedure.