Symptomatic Gallbladder Stones: From Occasional to Everyday in Pediatric Surgery

Abstract

Introduction: Gallbladder stones (GS) in children were once considered rare. In recent years, the rate of cholecystectomies appears to have increased. GS may present with symptoms in 60% of cases and can be simple GS (biliary colic) or complicated GS (cholecystitis, pancreatitis, choledocholithiasis). Laparoscopic cholecystectomy (LC) is the treatment of choice. The disease often leads to multiple emergency department visits and even hospitalizations, generating an increase in morbidity and public health costs. The objective of this study is to evaluate the clinical presentation, risk factors, complications, treatment, and evolution of GS in children. Materials and Methods: Retrospective, cross-sectional study in children from 0 to 14 years of age, who underwent cholecystectomy for symptomatic GS at the Hospital Nacional Prof. A. Posadas between January 2018 and July 2022 (54 months). Results: A total of 219 LCs were performed, 36 (2018), 39 (2019), 36 (2020), 62 (2021) and 47 (first half of 2022) in patients with a mean age of 12.3 years (3-14), 68% female, 25% overweight, 23% obese, 86 patients with family GS. 36% complicated GS (CGS); 29 patients presented cholecystitis, 26 choledochal syndrome, and 33 pancreatitis. 15% had 3 or more consultations prior to surgery and 12% began as biliary colic and later presented CGS. 62% of patients with cholecystitis presented microlithiasis as an ultrasound finding and 88% of patients with pancreatitis presented microlithiasis. ERCP was required in 17 patients, IOC in 6 (2.7%), Rendez Vous in 3 (1.37%). 21 patients (9%) with postoperative complications were reported, of which 1 required relaparotomy. Conclusions: The incidence of GS has increased considerably in the period studied. The data suggest that poor diet and family GS are factors to be considered in its development. Finally, the time of evolution and the delay in surgical resolution has led to a higher prevalence of CGS in our population, which is why we believe that patients with symptomatic GS should be operated on after diagnosis.