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Complications in pediatric laparoscopic cholecystectomy: systematic review

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Abstract

Laparoscopic cholecystectomy (LC) is the gold standard for surgical management in symptomatic children, but it is not without complications, bile duct injury being among the most feared. This study reviewed the complications of LC in children. MEDLINE/PubMed, CENTRAL and Lilacs were reviewed for LC. Studies in patients ≤ 18 years of age published in English, Portuguese or Spanish were selected by two independent reviewers. Data were collected for patients’ characteristics, surgical information, complications, mortality and follow-up. Twenty-four papers were identified and offered 2783 patients. Mean age was 11 years (3 months–18 years). In the 93/2783 (3.3%) complications, single-port procedures were associated with seven (7.5%), 3/4-port with 81 (87.1%) and the number of ports were not specified in five. Routine cholangiography was not part of the protocol in any of the reports. Complications included wound issues (n = 24), perforation (n = 14), bleeds (n = 13), biliary tree complications (n = 9), sickle cell crisis (n = 8), fever (n = 6), leaks (n = 4), pain (n = 3), nausea/emesis (n = 3) and others (n = 9). Two of these patients had a history of obesity and cholecystitis and only two biliary tree lesions were diagnosed intra-operatively. Seventeen cases (18.3%) required re-intervention: 15 surgical and two endoscopic. Issues related to biliary tree included: common bile duct lesion (n = 6), biliary fistula (n = 3), clip dislocation from cystic duct (n = 1), cholangitis (n = 1) and calculus (n = 1). There was no mortality, and the mean follow-up period was 10.3 months (1 month–5 years). LC is safe in children and, although most complications are minor, almost 1/5 complications require interventions, mostly due to bleeding and biliary tree complications. Mortality has not been reported in pediatric LC.

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Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors declare that they did not receive financial support from any source.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK

    Karina Miura da Costa & Amulya Kumar Saxena

  2. Department of Biological and Health Sciences, University Center of Maringá, Guedner Avenue, Maringa, Parana, 1610, Brazil

    Karina Miura da Costa

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KMC: acquisition, analysis and interpretation of data for the work; drafting the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved. AKS: conception and design of the work; acquisition, analysis, and interpretation of data for the work; revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Amulya Kumar Saxena.

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Not applicable—the present study was performed following all ethical requirements, and it did not directly involve human or animal subjects.

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Miura da Costa, K., Saxena, A.K. Complications in pediatric laparoscopic cholecystectomy: systematic review. Updates Surg 73, 69–74 (2021). https://doi.org/10.1007/s13304-020-00888-2

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