Cholelithiasis in children: diagnosis and treatment

Abstract

Introduction. Cholelithiasis in children is a rare disease. Making a decision on cholecystectomy in children is an urgent problem due to the lack of consensus on the tactics of managing children with cholelithiasis. Aim: determine the indications for surgical treatment of cholelithiasis in children based on laboratory and instrumental examination methods. Materials and methods. The study analyzed twenty seven patients operated on for cholelithiasis from 2018 to 2023. Results. Me = 18.7 months elapsed from the moment of diagnosis of cholelithiasis to surgery. In the prospective part of the work, 27 patients were studied, of which 26 were operated on. In 7 (26%) — the disease proceeded without symptoms, in 20 (74%) — pain syndrome was observed, in 4 — dyspeptic disorders were observed in the form of nausea and vomiting associated with food intake, in 2 — biliary sludge. According to the study, there was no statistically significant change in the level of C-reactive protein (p = 0.4). Analyzing the ESR data before and after surgical treatment, there was no statistically significant difference in the dynamics of this indicator (p = 0.223). In the trend in laboratory parameters, a statistically significant change in the parameters of leukocytes (p = 0.023) and neutrophils (p = 0.014) was revealed in the general blood test before and after surgical treatment. Conclusion. In children diagnosed with uncomplicated cholelithiasis, changes in laboratory parameters before and after surgery are uninformative and unreliable. In children with uncomplicated cholelithiasis, medical treatment was ineffective, as a result of which surgical treatment was indicated. The ineffectiveness of drug treatment and the deterioration of the general condition of the child are indications for surgical treatment. As a minimally invasive surgical intervention, laparoscopic CE is recommended.