Paediatric Cholecystectomy: Shifting goalposts in the laparoscopic era

S. Chan, James Currie, A. I. Malik, A. A. Mahomed

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice in symptomatic paediatric cholelithiasis. However, controversy exists about its role in asymptomatic cholelithiasis and biliary dyskinesia. We have reviewed the experiences of two UK paediatric centres with laparoscopic cholecystectomy over an 8.5 year period and critically evaluated the indications and outcomes of surgery.

METHODS: Patients who underwent laparoscopic cholecystectomy by a single surgeon at the Royal Aberdeen and Royal Alexandra Hospitals between May 1996 to August 2003 and September 2003 to December 2005, respectively, were studied. Information was extracted from prospectively held databases and analysed.

RESULTS: A total of 27 cholecystectomies were performed during the period of study. The mean age of patients was 11.7 years with a female preponderance. Symptomatic idiopathic cholelithiasis was the main indication for surgery (14). Cholecystectomy was also performed for haemolytic disease (3), acute recurrent pancreatitis of unknown cause (2), gallbladder trauma (1), and for asymptomatic calcific non-resolving stones (7). All patients were investigated with ultrasound scans with four patients undergoing magnetic resonance cholangiopancreatography (MRCP) for suspected common bile duct (CBD) stones. A standard four-port approach was used with the gallbladder extracted through the umbilical port. The mean operative time in the latter 13 cases was 105 minutes with a median postoperative stay of one day for the whole series. Histology revealed chronic cholecystitis in all but three cases. All patients were discharged after a six-month follow-up period.

CONCLUSIONS: The advent of laparoscopy has resulted in an expansion of the traditional indications for cholecystectomy. MRCP is a useful investigation in selected children to exclude choledocholithiasis and avoid intraoperative cholangiography. There appears to be no clear correlation between histology and presenting symptoms. The natural history of asymptomatic gallstones in children is not known although a consensus is emerging to support cholecystectomy for all calcific non-resolving gallstones.

Original languageEnglish
Pages (from-to)1392-1395
Number of pages4
JournalSurgical Endoscopy
Volume22
Issue number5
Early online date26 Jun 2007
DOIs
Publication statusPublished - May 2008

Fingerprint

Cholecystectomy
Cholelithiasis
Pediatrics
Laparoscopic Cholecystectomy
Magnetic Resonance Cholangiopancreatography
Gallstones
Gallbladder
Histology
Biliary Dyskinesia
Umbilicus
Choledocholithiasis
Cholecystitis
Cholangiography
Common Bile Duct
Acute Disease
Operative Time
Pancreatitis
Laparoscopy
Databases
Wounds and Injuries

Keywords

  • paediatric cholelithiasis
  • laparoscopy
  • choledocholithiasis
  • MRCP
  • cholecystectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Paediatric Cholecystectomy : Shifting goalposts in the laparoscopic era. / Chan, S.; Currie, James; Malik, A. I.; Mahomed, A. A.

In: Surgical Endoscopy, Vol. 22, No. 5, 05.2008, p. 1392-1395.

Research output: Contribution to journalArticle

Chan, S, Currie, J, Malik, AI & Mahomed, AA 2008, 'Paediatric Cholecystectomy: Shifting goalposts in the laparoscopic era', Surgical Endoscopy, vol. 22, no. 5, pp. 1392-1395. https://doi.org/10.1007/s00464-007-9422-6
Chan, S. ; Currie, James ; Malik, A. I. ; Mahomed, A. A. / Paediatric Cholecystectomy : Shifting goalposts in the laparoscopic era. In: Surgical Endoscopy. 2008 ; Vol. 22, No. 5. pp. 1392-1395.
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AB - BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice in symptomatic paediatric cholelithiasis. However, controversy exists about its role in asymptomatic cholelithiasis and biliary dyskinesia. We have reviewed the experiences of two UK paediatric centres with laparoscopic cholecystectomy over an 8.5 year period and critically evaluated the indications and outcomes of surgery. METHODS: Patients who underwent laparoscopic cholecystectomy by a single surgeon at the Royal Aberdeen and Royal Alexandra Hospitals between May 1996 to August 2003 and September 2003 to December 2005, respectively, were studied. Information was extracted from prospectively held databases and analysed. RESULTS: A total of 27 cholecystectomies were performed during the period of study. The mean age of patients was 11.7 years with a female preponderance. Symptomatic idiopathic cholelithiasis was the main indication for surgery (14). Cholecystectomy was also performed for haemolytic disease (3), acute recurrent pancreatitis of unknown cause (2), gallbladder trauma (1), and for asymptomatic calcific non-resolving stones (7). All patients were investigated with ultrasound scans with four patients undergoing magnetic resonance cholangiopancreatography (MRCP) for suspected common bile duct (CBD) stones. A standard four-port approach was used with the gallbladder extracted through the umbilical port. The mean operative time in the latter 13 cases was 105 minutes with a median postoperative stay of one day for the whole series. Histology revealed chronic cholecystitis in all but three cases. All patients were discharged after a six-month follow-up period. CONCLUSIONS: The advent of laparoscopy has resulted in an expansion of the traditional indications for cholecystectomy. MRCP is a useful investigation in selected children to exclude choledocholithiasis and avoid intraoperative cholangiography. There appears to be no clear correlation between histology and presenting symptoms. The natural history of asymptomatic gallstones in children is not known although a consensus is emerging to support cholecystectomy for all calcific non-resolving gallstones.

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