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Trends in management of gallbladder disorders in children
1Section of Pediatric Surgery, Department of Surgery, San Pablo Medical Center, Bayamón, Puerto Rico.
Insights
Laparoscopic cholecystectomy (LC) is a safe and effective treatment for pediatric gallbladder disease, offering superior outcomes compared to open cholecystectomy (OC). This minimally invasive approach leads to shorter hospital stays and faster recovery for young patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Gallbladder disorders are increasingly diagnosed in pediatric populations.
- Predisposing factors include contemporary diet, obesity, and abnormal liver chemistry.
- Female adolescents with classic biliary symptoms are the most affected demographic.
Purpose of the Study:
- To analyze trends in pediatric gallbladder disease management.
- To compare the efficacy of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC).
- To identify predisposing conditions and clinical outcomes in pediatric patients.
Main Methods:
- Retrospective chart analysis of pediatric cholecystectomies performed between 1990 and 1995.
- Data collection included demographics, symptoms, predisposing factors, surgical details, and outcomes.
- Statistical comparison of LC versus OC using clinical variables.
Main Results:
- Eighty-three pediatric patients (mean age 14.8 years) underwent cholecystectomy.
- Laparoscopic cholecystectomy (71%) was more common than open cholecystectomy (29%).
- LC demonstrated superiority over OC in reduced length of stay, faster diet resumption, less pain medication, shorter operative time, and better cosmetic results.
Conclusions:
- Laparoscopic cholecystectomy is the preferred surgical method for pediatric gallbladder disease.
- Gallbladder dyskinesia is a significant indication for surgery in children.
- Common bile duct stones can be effectively managed with simultaneous endoscopic papillotomy.
Abstract:
Gallbladder disorders have been recognized with increasing frequency in pediatric patients. This study aimed to identify recent trends in management and compare the effectiveness of laparoscopic (LC) over open cholecystectomy (OC) by a retrospective chart analysis of all cholecystectomies from 1990 through 1995. Information obtained included demographics, symptoms, predisposing conditions, associated illnesses, family history, imaging studies, type of cholecystectomy, complications, operative time, pain medication, diet recommencement, pathologic findings, and length of hospital stay. The type of cholecystectomy (OC vs. LC) was compared with the clinical variables using standard statistics. Eighty-three patients between 21 months and 18 years of age were identified; their mean age was 14.8 years. Females (76%) with classic biliary symptoms predominated;12% of the patients developed gallstone pancreatitis and 7% jaundice. Abnormal liver chemistry values, obesity, and elevated triglyceride levels comprised the most significant predisposing factors. Indications for surgery were cholelithiasis in 71 patients (86%), gallbladder dyskinesia in 10 (12%), and sludge/polyp in 2. Fifty-nine cholecystectomies (71%) were done laparoscopically and 24 (29%) open. Choledocholithiasis in 6 children (7%) was managed by open extraction with t-tube placement or endoscopic papillotomy followed by LC. No major ductal complication was identified. The predominant pathologic finding was chronic cholecystitis, including the subgroup with biliary dyskinesia. Statistical comparison showed that LC is superior to OC in regard to length of stay, diet resumption, use of pain medication, operating time, and cosmetic results. It is concluded that a contemporary diet, obesity, and abnormal liver chemistry are the main predisposing conditions of gallbladder disease in children in this decade. Females in their teenage years with typical symptoms continue to be the most commonly affected group. Persistent biliary symptoms associated with low gallbladder ejection fractions during hepatobiliary cholecystokinin-stimulated scans can be caused by dyskinesia. The method of choice to remove the diseased gallbladder in children is LC, which is safe, efficient, and superior to the conventional method. Common duct stones can be managed by simultaneous endoscopic papillotomy. The costs of LC are reduced by employing reusable equipment and selective cholangiographic indications.