Results and complications of laparoscopic cholecystectomy in childhood

Abstract

Background

The purpose of our study was to evaluate the results and complications of laparoscopic cholecystectomy in a case series of 110 infants.

Methods

Over a 5-year period (1993–98), we performed laparoscopic cholecystectomy in 110 pediatric patients. Surgery was performed at three different institutions by three different surgeons. The patients population was composed of 69 girls and 41 boys; their ages ranged from 1 to 16 years (median, 8.5). All of the 110 children had symptomatic cholelithiasis, which was confirmed at ultrasound examination. An associated pathology was present in 27 patients (sickle cell disease in 17 cases, hereditary spherocytosis in seven cases, thalassemia in three); the other 83 infants were affected by idiopathic cholelithiasis. In 107 patients, the operation was performed using four ports; in three patients, it was done using five ports. In three patients, we also performed a concomitant splenectomy.

Results

Median duration of simple cholecystectomy was 45 min (range, 25–75) and hospital stay ranged from 1 to 10 days (median, 2). Only 15 children required drainage. We had 17 complications in our series (15.5%), including a gallbladder perforation during dissection in 11 patients, a fall of stones into the abdominal cavity during extraction in one patient, and a trocar orifice infection in the postoperative period in five patients. At a maximum follow-up of five years (range, 1–5), all patients were doing well.

Conclusion

Laparoscopic cholecystectomy in children seems to be as effective as open surgery in cases of symptomtic cholelithiasis. In pediatric patients more than in adults, an accurate and precise dissection and a sound knowledge of possible congenital biliary abnormalities are essential to avoid any kind of complication.