Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing.

Gloria Pelizzo,Elettra Unti,Gregorio Rosone,Vennus Shafiei,Mario Milazzo,Valeria Calcaterra,Davide Rozze,Rossana Bussani,Salvatore Amoroso,Vincenza Girgenti,Giovanni Battista Mura,Marco Di Mitri,Annalisa De Silvestri

doi:10.3389/fped.2020.00203

Abstract

Background: Laparoscopic cholecystectomy (LC) is the standard of care for gallbladder (GB) pathologies. We evaluated clinical, ultrasonographic (US) data as well as histopathological findings in children affected with symptomatic cholecystic disease (SCD) who underwent LC, with the aim of defining surgical timing.Methods: We reviewed our cases who underwent elective LC (ELC) or urgent LC (ULC). Clinical, US, surgical and histological features were used to create different risk scores.Results: We considered 26 children (17 ELC/9 ULC). US signs were not different in the two groups (p > 0.05). Operating times were longer in ELC than in ULC (p = 0.01). Histopathological evaluation revealed fibrosis and atrophy in both ELC and ULC. The clinical risk score was higher in ELC compared to ULC (p < 0.001). An increased operative risk score was noted in patients with systemic inflammatory signs (OR1.98), lithotherapy (OR1.4.3) and wall thickening ≥3 mm (OR2.6). An increased histopathological risk score was detected in children with symptom duration >7 days (OR3.61), concomitant hematological disease (OR1.23) and lithotherapy (OR3.61).Conclusion: Criteria adopted in adults cannot be adopted to detect the severity of GB damage in children. A dedicated clinical and US score is mandatory to define the most appropriate surgical timing.

Highlights

The spectrum of gallbladder (GB) disorders in the pediatric population has changed over the past three decades [1]
The improved survival of critically ill newborns who have received long-term parenteral nutrition or have underlying abnormalities resulting in short-bowel syndrome is Laparoscopic Cholecystectomy in Children considered a new factor related to the increased incidence of cholelithiasis in children [1, 4, 5]
Laparoscopic cholecystectomy (LC) for calculous cholecystitis is the current standard of care for GB pathologies in children [6]

Summary

Introduction

The spectrum of gallbladder (GB) disorders in the pediatric population has changed over the past three decades [1]. While they were previously largely attributable to hemolytic diseases, the prevalence of pediatric cholelithiasis has proportionally increased with the childhood obesity epidemic [2, 3]. Laparoscopic cholecystectomy (LC) for calculous cholecystitis is the current standard of care for GB pathologies in children [6]. To date no evidence regarding a correlation between clinical severity and histopathological findings have been identified in the pediatric age. Laparoscopic cholecystectomy (LC) is the standard of care for gallbladder (GB) pathologies. Ultrasonographic (US) data as well as histopathological findings in children affected with symptomatic cholecystic disease (SCD) who underwent LC, with the aim of defining surgical timing

Methods

Results

Conclusion