Evaluation and management of cholelithiasis in children: a hospital based study

Abstract

Background:Earlier cholelithiasis was extremely unusual in childhood. Presently there is sharp increase in detection of cholelithiasis in children, which forms basis to investigate the overall changing pattern of cholelithiasis. This prospective study in referral centre has been under taken to evaluate childhood cholelithiasis and its management.Methods: The present prospective study was conducted in the Postgraduate Department of Surgery, GMC Jammu, Jammu & Kashmir, India over a period of two years. 80 patients in age group of 3-14 years were included in the study group with ultrasound proved cholelithiasis. Data reviewed with respect to patient demographics profile, clinical history including risk factors, imaging studies, operative techniques, postoperative complications, postoperative recovery and primary outcome parameters assessed accordingly.Results:During the study period 80 children (52 males and 28 females) with cholelithiasis were evaluated and treated by laparoscopic cholecystectomy. The mean age was 10.1 years (range 5 to 14 years). 75% patients (n = 60) belonged to rural background and rest to urban set up, 56 patients belonged to hindu religion and rest were muslims. In 47.5% patients no risk factor could be traced. Fifty two children (65%) had mixed gallstones. 78 patients underwent LC, two needed conversion and rest 02 children were subjected to mini cholecystectomy. The mean operative duration was 29.92 minutes (range 15-50 minutes). The average duration of hospital stay was 3.82 days (range 3-8 days). No major intra operative or post-operative complications could be detected except 01 case biliary peritonitis.Conclusions:Cholelithiasis in children was reported about three centuries back, remained relatively uncommon in the past but now it is evolving and ever increasing in frequency. In this part of country in almost 50% of patients risk factors could not be traced, obesity could not be held responsible for cholelithiasis. Male children with low socioeconomic status, rural area and belonging to Hindu religion were more affected by the disease. In view of high incidence of serious complications of gall stones in children and because of longer life expectancy we also recommend that expectant management of gallstones may not be safe and hence laparoscopic cholecystectomy must be done even in asymptomatic cholelithiasis.