Laparoscopic Cholecystectomy In Children Research Articles

Comparison of laparoscopic cholecystectomy in children at paediatric centres and adult centres: a systematic review and meta-analysis.

Paediatric laparoscopic cholecystectomy (LC) is performed by both paediatric and adult surgeons. The aim of this review was to compare outcomes at paediatric centres (PCs) and adult centres (ACs). A literature search was conducted, in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, for papers published between January 2000 and December 2020. Statistical analysis was performed using Stata® version 16 (StataCorp, College Station, TX, US). A total of 92 studies involving 74,852 paediatric LCs met the inclusion criteria. Over half (59%) of the LCs were performed at ACs. No significant differences were noted in the male-to-female ratio, mean age or mean body mass index between PCs and ACs. The main indications were cholelithiasis (34.1% vs 34.4% respectively, p=0.83) and biliary dyskinesia (17.0% vs 23.5% respectively, p<0.01). There was no significant difference in the median inpatient stay (2.52 vs 2.44 days respectively, p=0.89). Bile duct injury was a major complication (0.80% vs 0.37% respectively, p<0.01). Reoperation rates (2.37% vs 0.74% respectively, p<0.01) and conversion to open surgery (1.97% vs 4.74% respectively, p<0.01) were also significantly different. Meta-analysis showed no significant difference in overall complications (p=0.92). The number of LCs performed, intraoperative cholangiography use and conversion rates were higher at ACs whereas bile duct injury and reoperation rates were higher at PCs. Despite a higher incidence of bile duct injury at PCs, the incidence at both PCs and ACs was <1%. In complex cases, a joint operation by both paediatric and adult surgeons might be a better approach to further improve outcomes. Overall, LC was found to be a safe operation with comparable outcomes at PCs and ACs.

Laparoscopic Cholecystectomy in Children: The Experience of Two Centers Focusing on Indications and Timing in the Era of "New Technologies".

In children, laparoscopic cholecystectomy (LC) is now considered the gold standard for gallbladder (GB) removal. In the past, hemolytic disorders associated with cholelithiasis represented the most frequent conditions requiring LC; this is being overtaken by cholelithiasis and biliary conditions in overweight or ex-premature children. This study aims to describe current indications and timing for LC in pediatric patients. Retrospective study. Data on previous medical therapy, ultrasound, pre- and intraoperative aspects, and histology were collected for patients treated in 2020-2023. In total, 45 patients were enrolled: 15 who underwent urgent surgery and 30 electives. Groups differed in terms of obesity rate, symptoms, ultrasound features, and intraoperative status. The most relevant risk factors for surgical complexity were age and pubertal stage, elevated cholestasis indexes, and gallbladder wall thickness > 3 mm at ultrasound. GB wall thickening ≥3 mm, US Murphy sign, fluid collections, and gallbladder distention on ultrasound correlated with high surgical scores. Indications for laparoscopic cholecystectomy in children seem to evolve caused by changing characteristics of the pediatric population. Patients with overweight/obesity may develop more complex GB diseases. Asymptomatic patients should be considered for surgery after observation, considering age and/or pubertal maturation when other risk factors are absent.

The Outcomes of Laparoscopic Cholecystectomy in Children Compared to Adults: A Multiple Iraqi Centers Study

The Outcomes of Laparoscopic Cholecystectomy in Children Compared to Adults: A Multiple Iraqi Centers Study

Laparoscopic cholecystectomy in children: A systematic review and meta-analysis

BackgroundLaparoscopic cholecystectomy (LC) has become the procedure of choice for the removal of gallbladder within the paediatric population. The aim of this study was to perform a systematic review and meta-analysis of the literature spanning the last 20 years to understand the indications for and safety of LCs in children. MethodsA comprehensive search of the published English language literature from January 2000 to June 2020 was done on PubMed, MEDLINE, and Google Scholar. ResultsIn total, 76,524 LC cases were identified from 114 studies. 78.9% of the patients were female and average age was 12 years old. Associated haematological disorders were identified in 16% of cases. The commonest indication for LC was cholelithiasis (68.4% in 66 studies), followed by cholecystitis (59.2% in 53 studies). Median operating time was 77 min. Median hospital stay was 2 days. The overall postoperative complication rate was 3.4% Major complications included bile duct injury (0.4%) and intra- or post-operative bleeding (0.9%). The conversion rate to open procedure was 2%. When comparing post-operative outcomes between emergency and elective admissions, three papers lent themselves to meta-analysis demonstrating no significant difference (p = 0.42). There was no statistically significant difference in postoperative complication rate between “hot” and “cold” laparoscopic cholecystectomies (p = 0.6). ConclusionThis systematic review and meta-analysis is the largest collection of subjects on laparoscopic cholecystectomies in children. Laparoscopic cholecystectomy is a safe operation in children, with complication rates similar or comparable to the adult literature. Cholelithiasis, cholecystitis and biliary dyskinesia were the commonest indications for LC.

Evaluation of the safety of using harmonic scalpel during laparoscopic cholecystectomy in children: A preliminary report.

Background and objectiveIn spite of being one of the most common surgical procedures performed in adults, laparoscopic cholecystectomy (LC) is relatively uncommon in the pediatric age group. Most surgeons prefer to dissect the cystic duct using a monopolar electrosurgical hook and occlude it with simple metal clips. Although the safety of using the ultrasonically-activated shears, e.g., harmonic scalpel for dissection of the gallbladder is confirmed in many studies, its efficacy in the closure of the cystic artery and duct in adults is still debatable. Furthermore, very few reports studied its safety in children during LC. The aim of our work is to study the safety and efficacy of ultrasonic shears in controlling the cystic duct and artery during LC in children.Materials and methodsA prospective study was conducted from May 2017 to April 2020, where all children having symptomatic gallbladder stone disease were included in the study. HS was used as a sole instrument in gallbladder dissection as well as in controlling cystic duct and artery. No metal clips or sutures were used throughout the procedure.ResultsA total of forty-two children having symptomatic gallstone disease were included in the study. The main indication for LC was hemolytic anemia. Their age ranged from 3 to 13 years with a mean of 8.4 ± 3.25 years. All operations were completed laparoscopically, i.e., no conversion to open surgery was needed. The mean operative time was 40 ± 10.42 min. There were no intraoperative complications apart from gall bladder perforation in two cases during dissection from the liver bed while the postoperative recovery was smooth in all patients. Patients started oral feeding after 11.30 ± 3.01 h. The mean time for discharge was 25.47 ± 7.49 h, ranging from 14 to 48 h. Postoperative ultrasound for all cases showed no evidence of minor or major bile leaks or CBD injuries.ConclusionThis is the first report to evaluate the use of HS as a sole instrument during LC in the pediatric age group. HS is a safe and efficient instrument that can be used alone in gallbladder dissection as well as in controlling cystic duct and artery during LC in children.

Postoperative complications of laparoscopic cholecystectomy in children: two cases report

Only a few studies have investigated the complications of laparoscopic cholecystectomy in children. Therefore, relevant case reports will be of interest to pediatric surgeons.&#x0D; The patient was a 10-month-old boy diagnosed with calculous cholecystitis who underwent laparoscopic cholecystectomy. He had peripheral edema and adhesions in the neck of the gallbladder. After 10 h, a clinical picture of intra-abdominal bleeding developed. During relaparoscopy in the area of the gallbladder bed, arterial bleeding from the liver vessel was noted, which was eliminated by coagulation. The postoperative period was uneventful, and the child was discharged on day 8. In the second case, a 10-year-old girl was admitted for chronic calculous cholecystitis, and laparoscopic cholecystectomy was performed, in which a pronounced adhesion process was noted in the gallbladder neck region. On day 8, the child was discharged home; however, after 26 days, the patient was admitted again, with a clinical picture of diffuse biliary peritonitis. During laparoscopy, bile outflow from the gallbladder bed was noted, which only partially eliminated by monopolar electrocoagulation. Drainages were installed, through which bile began to be abundantly secreted in the postoperative period. Laparoscopy with a transition to open surgery was performed, during which a perforation in the wall of the common bile duct was found, and stenting and suturing of the defect were performed. In the postoperative period, active infusional infusion and antibacterial therapy were given. The patient was discharged on day 29.&#x0D; Postoperative complications of the ClavienDindo type IIIb are associated both with the presence of congenital anatomical features and inflammatory-adhesive changes in the Calo triangle zone and with the possibility of latent lesions during monopolar coagulation in both cases. The evaluation of the tactics of eliminating biliary peritonitis in the second patient emphasized the necessity to switch to open laparotomy during the second operation.&#x0D; These cases indicate the need to comply with the principles of safe laparoscopic cholecystectomy, including the availability of modern endoscopic equipment and the experience of surgeons in endosurgery. This requires the concentration of patients with cholelithiasis in specialized clinics.

Laparoscopic Cholecystectomy in Children.

The incidence of gallbladder disease in children is rising due to an increase in the development of nonhemolytic cholelithiasis in this age group. Laparoscopic cholecystectomy is the gold standard for treatment for gallbladder disease in adults and, with the technique's widespread adoption, it has now become the mainstay of treatment for gallbladder disease in children as well. Complications are infrequent and is now often performed as an outpatient surgery. Although the standard approach is through a 4-port technique, it can also be performed using a single-site technique. We describe our thoughts on laparoscopic cholecystectomy in children with a focus on the standard approach.

Complications in pediatric laparoscopic cholecystectomy: systematic review.

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 ≤ 18years 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 11years (3months-18years). 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 10.3months (1month-5years). 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.

A Multicenter Randomized Prospective Study of Early Cholecystectomy for Pediatric Patients with Biliary Colic

BackgroundIn patients with biliary colic, high-quality prospective data supporting the precise timing of cholecystectomy are lacking. The purpose of this study was to determine the effectiveness of early laparoscopic cholecystectomy in children with biliary colic. MethodsA multicenter, parallel-group, randomized study was conducted in patients with biliary colic at 5 hospitals in China. Pediatric patients with biliary colic were prospectively randomized to either the early cholecystectomy or conservative management strategy. The clinical outcomes within 6 months, including the number of biliary colic-free patients and gallstone-related complications, were compared (register number ChiCTR1900021830). ResultsDuring the first 2 months of follow-up, 71 patients (59.2%, 71/120) receiving conservative management and 124 patients (97.6%, 124/127) in the early cholecystectomy group (p < 0.001) reported being entirely colic-free. The GIQLI measures were higher in the early cholecystectomy group than in the conservative management group (p = 0.032). Acute readmissions occurred in 7 (5.5%) of 127 patients in the early cholecystectomy group, compared with 23 (19.2%) of 120 patients in the conservative management group (risk ratio [RR] 0.25; 95% CI [0.10–0.60], p = 0.001) in the 6-month period. ConclusionsEarly cholecystectomy is effective in providing beneficial outcomes in terms of both short-term and long-term improvement of symptoms.

Association of hospital and surgeon operative volumes and surgeon pediatric subspecialization with pediatric laparoscopic cholecystectomy outcomes: A population-based cohort study

BackgroundMost pediatric cholecystectomies are performed by adult general surgeons, but it is unclear whether outcomes differ by surgeon pediatric subspecialization, hospital procedure volume, or surgeon procedure volume. We aimed to determine whether higher hospital or surgeon laparoscopic cholecystectomy (LC) volume or surgeon pediatric subspecialization is associated with better outcomes after LC in children. MethodsWe performed a retrospective cohort study using statewide hospital discharge databases from the states of Florida, Georgia, and Iowa. We included children aged 4–18 years who underwent inpatient or outpatient LC for acute or chronic gallbladder disease in January 2010–August 2015.Propensity score weighting was used to estimate relationships between operative volumes or surgeon pediatric subspecialization and rates of readmission or emergency department (ED) visit within 30 days. ResultsA total of 5391 children were included (mean age 15.9 years, 81.6% female). Children operated on by surgeons with high LC volumes in hospitals with high LC volumes were less likely to experience a readmission or ED visit within 30 days (10.8% vs. 13.7%, p = 0.04). Additionally, children operated on by adult general surgeons in hospitals with high LC volumes were less likely to experience a readmission or ED visit within 30 days (10.9% vs. 13.8%, p = 0.03). ConclusionsChildren are less likely to be readmitted to the hospital or present to the ED after laparoscopic cholecystectomy if they receive their care from adult general surgeons at hospitals that frequently perform this procedure in both adults and children. Level of evidenceIII

Laparoscopic cholecystectomy by paediatric surgeons: can established standards of care be delivered?

Laparoscopic cholecystectomy (LC) case volume is low for paediatric surgeons relative to the adult sector; coupled with service differences, internationally accepted standards may be more challenging to meet. This study sought to determine (i) the outcomes of LC in children, and (ii) whether recognised care pathways (e.g. acute LC, access to cholangiogram/ERCP and day-case LC provision) can be delivered. Patients who underwent LC were identified retrospectively in a single institution between January 2009 and January 2019. Data are presented as median [IQR] and continuous variables compared using a t test. 101 cases were included (age 12.9 years [10.2–15]; female 65/101). Indications for LC were symptomatic gallstones (98/101) and polyps (2/101). ERCP and/or endoscopic ultrasound were performed in 23/101. For acute presentations, 7/24 (29%) had LC during the same admission. Trainees performed LC in 33/101. 4/101 required intra-operative cholangiogram. Operative time was 109.5 min [90.8–139.5]: consultant vs. trainee times were similar (114 [93.3–149.5] vs. 99.5 [81.5–125.3], p = 0.06). Length of stay was one day [1–1] with 10/101 being day-cases. There were no major complications or re-operations. We report good outcomes from LC. Furthermore, we have demonstrated the capacity to deliver recognised standards of care within a paediatric setting.

Laparoscopic cholecystectomy in children with sickle cell disease: A simple modified technique

Sickle cell disease and other hemoglobinopathies are prevalent in Bahrain. In our hospital, we often encounter children with gallstones; sometimes gallstones are discovered on routine abdominal ultrasound, and in other cases, patients present with symptoms. Elective cholecystectomy has been controversial in patients with sickle cell disease and cholelithiasis because surgery can be a challenge. Therefore, the aim of this study was to assess the safety of elective cholecystectomy in children with sickle cell disease with cholelithiasis, as well as the safety and efficacy of a simple modification to the conventional laparoscopic cholecystectomy technique using two natural creases in the skin. The modified technique employs four ports, two of which were placed in natural crease lines, specifically the umbilicus and the groin crease. The procedure was elective for patients with sickle cell disease with gallstones. All patients received either a preoperative blood transfusion or an exchange transfusion to reduce the risk of postoperative sickle cell complications. Eighty-one patients with sickle cell disease with gallstones underwent our simple modified laparoscopic cholecystectomy procedure. The mean ± SD operative time was 58.43 ± 8.02 minutes (range, 45-80 minutes). Only eight patients (9.9%) experienced postoperative complications; six had fever, and two had a sickle cell crisis. None of the patients required conversion to open cholecystectomy or intensive care management. Our simple modified laparoscopic cholecystectomy using two skin creases is a safe and feasible elective procedure in children with sickle cell disease that provides excellent cosmesis.

Selective intraoperative cholangiography during laparoscopic cholecystectomy in children is justified

AimsIntraoperative cholangiograms (IOC) during laparoscopic cholecystectomy have been advocated to detect biliary anomalies and intraductal calculi. However, IOC increases operative time and patient irradiation, and therefore is not universally used. We hypothesise selective IOC may be a valuable tool in children. MethodsA retrospective case note review was performed of all children who underwent laparoscopic cholecystectomy at a single institution by a single surgeon between January 2011 and March 2017. Demographics, radiological imaging, indications for surgery and IOC, and clinical outcomes were collected. Chi-Squared and Wilcoxon Rank Sum tests were used for comparisons. ResultsSixty-two patients were reviewed. Median follow-up was 2 months (0.1–60), and 53 (85%) had complete symptom resolution following surgery. Twenty-two patients underwent IOC. Six (27%) had anomalies undetected by preoperative imaging. IOC identified common bile duct (CBD) stones in 2 patients which were cleared at laparoscopy. One patient required subsequent ERCP for impacted stones. One patient has a long common channel and pancreatitis. Two patients have CBD strictures. These last 3 are awaiting biliary reconstruction. Presence of CBD dilatation or ductal stones on preoperative ultrasound were significantly associated with positive findings at IOC. No complications resulted from IOC. Patients who did not undergo IOC did not represent with missed anomalies. ConclusionsDespite using multimodal preoperative imaging, IOC detected biliary anomalies requiring further treatment in 6/62 (10%) of patients undergoing laparoscopic cholecystectomy. Our data support the use of IOC in selective patients with CBD dilatation or suspicion of ductal stones on preoperative imaging. Level of evidenceStudy of Diagnostic Test: Level III.

Variation in prophylactic antibiotic use for laparoscopic cholecystectomy: need for better stewardship in pediatric surgery

PurposeThe role of prophylactic antibiotics for elective laparoscopic cholecystectomy has been questioned over the last decade. Although gradually being discontinued in the adult population, the practice among pediatric surgeons remains unknown. Our aim was to investigate the use of perioperative antibiotics in children undergoing elective laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis and biliary dyskinesia. MethodsWe retrospectively reviewed the Pediatric Health Information System (PHIS) database for 2015 and selected all patients 18years old or younger who underwent LC for cholelithiasis (without cholecystitis) or biliary dyskinesia. Demographic and hospital data were extracted as well as antibiotics administered and surgical complications. ResultsA total of 1112 patients from 44 hospitals were identified with a median age of 15years (IQR 13–16years). Eight out of every 10 hospitals routinely give prophylactic antibiotics in more than 50% of patients. In 37 hospitals that performed more than 5 LC per year, 19 to 100% of patients were given antibiotics. No surgical complications were identified in those who did not get antibiotics. ConclusionThere is significant inter-hospital variation in prophylactic antibiotic administration for elective LC in children. Perioperative antibiotic administration should be tracked as a quality metric in the current push for better stewardship. Level of evidenceIII. Type of studyRetrospective.

Safety of laparoscopic cholecystectomy in children using conventional instruments in a general teaching hospital by general surgeons: 14 years review

Introduction: There is limited specialist facility and lack of data on gallstone and laparoscopic cholecystectomy (LC) in children locally and in the region. With one government children hospital in Nepal, specialist service is far from adequate. Utilizing existing facilities to provide service is the need. We analyzed 14 years data to look in to the safety of LC in children provided by general surgeons in a general teaching hospital with conventional LC instruments used for adults.&#x0D; Methods: This descriptive review included children up to 14 y of age who had cholecystectomy during 14 y period from 2002 to 2015. Data on sex, age; clinical and ultrasonography findings; risk factors for gallstone; types of surgeries; bile duct injury, would infection and in-hospital mortality were analyzed.&#x0D; Results: There were 61 children, 0.8% of total 7469 cholecystectomy during 14 years study period. Average age was 9 years and females were 56 (84%). Out of 58-attempted LC, 56 were completed successfully. All children had history of right upper quadrant pain. Two presented with acute calculous cholecystitis. We did not find associated risk factors for stones. There was no bile duct injury. One wound infection occurred in LC converted to open. In-hospital mortality was nil.&#x0D; Conclusion: Cholelithiasis and cholecystectomy in children was low at 0.8% of total. With 3.4% conversion, no bile duct injury, no hospital mortality LC was safely provided by general surgeon in a general hospital using conventional facility.

Two-Incision Laparoscopic Cholecystectomy in Children.

To evaluate two-incision laparoscopic cholecystectomy (2I-LC) in children, and compare outcomes with four-port laparoscopic cholecystectomy (4P-LC). A retrospective review was performed on children (≤21 years) with gallbladder disease treated with 2I-LC or 4P-LC between February 2010 and February 2016. 2I-LC is performed using two 5-mm ports and a 2-mm endoscopic grasper within a 12-mm umbilical incision, and a 3-mm subxiphoid port for dissection. Demographic, diagnostic, operative, and outcome data were recorded, and the two groups were compared with chi-squared, Fisher, and t-tests. Patients requiring conversion from 2I-LC to 4P-LC were examined to determine factors predicting the need for additional ports. Three hundred eighty-nine laparoscopic cholecystectomies were performed (2I-LC 72.0%, 4P-LC 19.0%). Body mass index (BMI) was greater in the 4P-LC group. 2I-LC was more commonly performed for biliary dyskinesia, but not biliary colic, acute cholecystitis, choledocholithiasis, and gallstone pancreatitis. Operative time was greater in 4P-LC. There were 6 wound infections (2I-LC 1.8%, 4P-LC 1.5%), 1 common bile duct injury (2I-LC 0.4%, 4P-LC 0.0%), and 1 small bowel injury (2I-LC 0.0%, 4P-LC 1.5%). 2.4% of 2I-LC required conversion to 4P-LC, with BMI and operative time greater than the 2I-LC group, but not different from 4P-LC with no complications. 2I-LC is a safe alternative to 4P-LC for pediatric gallbladder disease, allowing for traction and countertraction to expose the critical view. Operative time was longer in the 4P-LC group, likely secondary to selection bias with higher BMI and preoperative diagnosis of gallstone disease. Overweight patients are more likely to require additional ports.

Laparoscopic cholecystectomy in childhood: a review of twenty-four consecutive cases

Background. The experience with laparoscopic cholecystectomy in children remains limited. Therefore, we aimed to present our experience with this procedure. Methods. Between April 2011 and June 2016, retrospectively, data points of children who underwent laparoscopic cholecystectomy reviewed included demographics properties, indication for cholecystectomy, surgical technique, operative time, complications, and length of hospital stay. Results. Twenty-four children (5 were males with ages ranging from 2 to 17 years, mean: 10.5 years) underwent laparoscopic cholecystectomy. The indication for surgery was associated to symptomatic gallstones in 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 90 minutes (mean: 60 minutes). Two patients ended by open surgery. No complications occurred. Hospital stays ranged from 1-3 days. Conclusion. Laparoscopic cholecystectomy is safe and effective in children, and shows the same advantages reported in adults series.

Safety of outpatient laparoscopic cholecystectomy in children: analysis of 2050 elective ACS NSQIP-pediatric cases.

Limited data exists evaluating the extent of utilization and safety of outpatient laparoscopic cholecystectomy (LC) in children. The aim of this study was to investigate the safety of outpatient LC in the pediatric population utilizing a national surgical quality improvement database. The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) databases from 2012 and 2013 were queried to identify pediatric patients who underwent elective LC. Patients who underwent outpatient LC were compared with those who underwent inpatient LC. Outcomes of interest included 30-day overall morbidity, readmission, and reoperation. A total of 2,050 LC were identified, 995 (48.5%) were performed as an outpatient procedure and 1055 (51.5%) as inpatient. Patients who underwent outpatient LC were more often white (79.6 vs. 69.2%; p=<0.0001). Choledocholithiasis was more often treated in inpatient setting (12.5 vs. 1.7%; p<0.0001), while biliary dyskinesia was performed in outpatient setting (26.1 v. 12.6%; p=0.0001). Overall 30-day morbidity was greater in the inpatient group (2.5 vs. 0.8%; p=0.03). There were no differences in term of 30-day readmission rate and related reoperations (0.9 vs 0.3% respectively; p=0.09). This analysis of a large multicenter dataset demonstrates that pediatric patients without significant associated comorbidities can safely undergo laparoscopic cholecystectomy as an outpatient procedure.

Laparoscopic cholecystectomy in children: One centre experience

The incidence of cholelithiasis in children is assessed to range from 0.13 to 1.9%. Symptomatic cholelithiasis in children requiring surgery has increased in tendency over the past ten years. Food habits, obesity and family history are the most common risk factors. Aim of the study was evaluation of the indications, methods and results of cholelithiasis treatment in children. From June 2011 to December 2014, 74 consecutive patients aged 3–18 years were treated due to symptomatic cholelithiasis. In 72 patients, laparoscopic cholecystectomy (LC) was performed; in the analyzed group there were 56 girls and 18 boys. A total of 48 patients underwent an elective operation. Urgent hospitalization was required by 26 patients due to acute biliary colic in 16, cholecystitis in five, hydrops of the gallbladder in two, jaundice in two and acute pancreatitis in one patient. LC was performed after resolution of symptoms. In all cases except four, LC was performed with the three-port technique. In four cases of spherocytosis, splenectomies were completed during the same procedure and requiring insertion of an additional fourth port.There were no intraoperative complications demanding reoperation. Minor complications included postoperative vomiting requiring antiemetic medications in 28 patients, pain located in the shoulder region in nine patients and elevation of temperature in the postoperative period in eight. Laparoscopic surgery is a safe procedure in children for removal of the gallbladder. Age of the patient is not a contraindication to the operation, and LC may be performed even in young children with symptomatic gallbladder disease.

Same day discharge after laparoscopic cholecystectomy in children

BackgroundAlthough the safety of same day discharge (SDD) after laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis (SC) and biliary dyskinesia (BD) in adults has been well documented in the literature, the same data in the pediatric population are lacking. We have recently instituted a protocol for SDD after LC for SC and BD, and this study is an analysis of our initial experience. MethodsA retrospective chart review of all patients who underwent LC for BD and SC in our institution from January 2011–July 2014 was performed. ResultsA total of 227 LC were performed for SC and BD during the study period. Approximately 25% (n = 57) of patients were in the SDD group. The remaining 75% (n = 170) of patients were admitted at least overnight stay (ONS) for the following reasons: medical 16.5% (n = 28), surgery ending too late 4.1% (n = 7), or clinical care habits 79.4% (n = 135). Comparing the SDD group with ONS group, no differences were found in the complication rate, readmissions, or follow up before scheduled appointment. Length of stay was significantly less for the SDD group than for the ONS. A trend for more SDDs was observed as time elapsed from initiation of the protocol. Also, earlier completion of surgery trended toward SDD. ConclusionsSDD appears safe for pediatric patients undergoing LC for BD or SC. The main obstacles to discharge were time of surgery completion and clinical care habits, both of which improved as comfort level with SDD grew among the staff.