Pediatric Cholelithiasis Single Center Experience Results of the Clinic for Pediatric Surgery kcu Sarajevo in Period 2010.-2022

Abstract

Introduction: Cholelithiasis is occurance of one or several gallstones in the gallbladder. It can be complicated with choledocholithiasis, acute or chronic cholecystitis, cholangitis, biliary pancreatitis, biliary ileus, etc. Causes for this disorder in pediatric population can be hemolytic (hereditary spherocytosis, thalassemia, sickle cell anemia) or non hemolytic - other hereditary disorders as cystic fybrosis, Wilson's disease or ileum disordes, total parenteral nutrition, usage of certain medicaments, choledochal cysts, organ transplantation and, in adolescency, those similar to adult patients (obesity). Mostly gallstones found in children are cholesterol ones or pigmented gallstones. There are many diagnostic imaging methods for objectifying gallstones and its complications (as choledocholithiasis that requires ERCP). There is also some differential dyagnoses that should be taken in consideration before the tretment (billary dyskinesion, Odii sphincter dysfunction, neonatal jaundice, cholestasis, pediatric cholecystitis, pediatric pancreatitis and pancreatic pseudocysts as well as pediatric pyelonephritis). First line of treatment of cholelithiasis is with diet, saline infusions and medicaments and if cholelithiasis is symptomatic and/or complicated then cholecystectomy is recomended. Having in mind operative approach it can be open procedure of laparascopic one. Some study show that injuries of bile ducts are more common in laparascopic tretment of pediatric cholelithiasis but nevertheless it is shown that with experienced team and good preparation this is the golden standard in the treatment of pediatric cholelithiasis. Objectives. Hereby we present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis in pediatric population. Methods: Between 2010. and 2022, retrospectively, we explored data points of children who underwent laparoscopic cholecystectomy reviewed with included demographics properties, indication for cholecystectomy, used surgical technique, operative time, complications, and length of hospital stay. We performed 37 laparoscopic cholecystectomies (due to cholelithiasis and one case of cholecystitis without calculi) with 2 conversions to open procedures and via open approach we treated 3 cholecystes in this period. Male to female distribution was: 12 male patients and 25 female patients Results: Thirty-seven children (12 male patients and 25 female patients with ages ranging from 7 to 18 years, mean: 11,9 years) underwent laparoscopic cholecystectomy. The indication for surgery was associated to symptomatic cholelithiasis in almost all patients. The surgery was performed under general anesthesia and classical 4-port approach was done in twenty-two patients, and 2-port approach in combination with 2 portless 2.3-mm percutaneous graspers was used in two patients. The operating time ranged between 45 and 120 minutes (mean: 77 minutes). Two patients were treated by open surgery. Only one patient had leakage due to choledocholithiasis, and open surgery and ERCP had to be performed. Median of hospital stay for all patients was 3-4 days. Conclusion: Laparoscopic cholecystectomy is safe and effective in children, and shows the same advantages reported in adult series.