Gallbladder Stones in Pediatric Age: An Emerging Problem: The Risk of Difficult Cholecystectomy and the Importance of a Preoperative Evaluation
Author:
Todesco Camilla12, Molinaro Francesco2, Nascimben Francesca2, Gentilucci Gianluca2, Messina Mario2, Cortese Andrea3, Briganti Vito1, Tursini Stefano1
Affiliation:
1. Operative Unit of Pediatric Surgery—Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy 2. Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, Policlinico Le Scotte, University of Siena, 53100 Siena, Italy 3. Operative Unit of Radiology and Diagnostic Imaging—Azienda Ospedaliera San Camillo Forlanini, 00152 Roma, Italy
Abstract
The need for cholecystectomy during pediatric age has significantly increased in the last two decades. As biliary pathology increases, the probability of complicated cholecystectomies increases too. The aim of this article is to analyze our experience with difficult laparoscopic pediatric cholecystectomy, focusing on the importance of an accurate pre-operative imaging study. We retrospectively analyzed all patients affected by cholelithiasis who underwent laparoscopic cholecystectomy at the Pediatric Surgery Department of San Camillo Forlanini hospital of Rome and Santa Maria alle Scotte University Hospital of Siena from 2017 to 2022. Demographic data, body mass index (BMI), recovery data, laboratory tests, imaging exams, surgical findings, post operative management and outcome were taken into account. Overall, 34 pediatric patients, with a mean age of 14.1 years (6–18 years) were included, with a mean BMI of 29. All patients underwent abdominal ultrasonography and a liver MRI with cholangiography (cMRI). We identified five cases as “difficult cholecystectomies”. Two subtotal cholecystectomies were performed. Cholecystectomy in pediatric surgery can be difficult. The surgeon must be able to find alternative strategies to total cholecystectomy to avoid the risk of possible bile duct injury (BDI). Pre-operative imaging study trough ultrasound and especially cMRI is crucial to recognize possible difficulties and to plan the surgery.
Subject
Pediatrics, Perinatology and Child Health
Reference25 articles.
1. National trends in the utilization of cholecystectomy in children;Balaguer;J. Surg. Res.,2006 2. Is 14 the new 40: Trends in gallstone disease and cholecystectomy in Australian children;Greer;Pediatr. Surg. Int.,2018 3. Clinical Characteristics and Risk Factors for Symptomatic Pediatric Gallbladder Disease;Mehta;Pediatrics,2012 4. Frybova, B., Drabek, J., Lochmannova, J., Douda, L., Hlava, S., Zemkova, D., Mixa, V., Kyncl, M., Zeman, L., and Rygl, M. (2018). Cholelithiasis and choledocholithiasis in children; risk factors for development. PLoS ONE, 13. 5. Zdanowicz, K., Daniluk, J., Lebensztejn, D.M., and Daniluk, U. (2022). The Etiology of Cholelithiasis in Children and Adolescents—A Literature Review. Int. J. Mol. Sci., 23.
|
|