Pediatric cholelithiasis and laparoscopic management: A review of twenty two cases

Abstract

Aim: To evaluate the role of laparoscopic cholecystectomy (LC) in the management of cholelithiasis in children.

Materials and methods: A retrospective review of our experience with LC for cholelithiasis at our institution, between April 2006 and March 2009 was done. Data points reviewed included patient demographics, clinical history, haematological investigations, imaging studies, operative techniques, postoperative complications, postoperative recovery and final histopathological diagnosis.

Results: During the study period of 36 months, 22 children (10 males and 12 females) with cholelithiasis were treated by LC. The mean age was 9.4 years (range 3 to 18 years). Twenty-one children had symptoms of biliary tract disease and one child was incidentally detected with cholelithiasis during an ultrasonogram of the abdomen for an unrelated cause. Only five (22.7%) children had definitive etiological risk factors for cholelithiasis and the remaining 13(77.3%) cases were idiopathic. Twenty cases had pigmented gallstones and two had cholesterol gallstones. All the 22 patients underwent LC, 21 elective and one emergency LC. The mean operative duration was 74.2 minutes (range 50-180 minutes). Postoperative complications occurred in two (9.1%) patients. The average duration of hospital stay was 4.1 days (range 3-6 days).

Conclusion: Laparoscopic chloecystectomy is confirmed to be a safe and efficacious treatment for pediatric cholelithiasis. The cause for an increased incidence of pediatric gallstones and their natural history need to be further evaluated.

Keywords: Children; cholelithiasis; laparoscopic cholecystectomy.

Figure 1

Diagrammatic representation of port placement for laparoscopic cholecystectomy in children

Figure 2

Laparoscopic intraoperative view of Calot's triangle showing clear anatomy

Figure 3

Gall bladder specimen with multiple pigment gallstones