Laparoscopic cholecystectomy in children: Lessons learned from the first 100 patients

Background/Purpose: Laparoscopic cholecystectomy is a very common operation in adults but is relatively infrequently required in children. A retrospec tive review of 100 consecutive infants and children undergoing laparoscopic cholecystectomies from 1990 to 1998 was performed to see what lessons have been learned from this relatively large population of pediatric patients. Results:The patients ranged in age from 25 to 230 months, with a mean of 10 5 months. Only 19 patients had hemolytic disease as the etiology for their cholelithiasis. Two patients had biliary dyskinesia. Seventy-eight patients underwent an elective operation. Twenty-two children required urgent hospi talization because of complications from their cholelithiasis: acute cholec ystitis (n = 7), jaundice and pain (n = 6), gallstone pancreatitis (n = 5), acute biliary colic (n = 4). All 6 patients who presented with jaundice un derwent endoscopic retrograde cholangiopancreatography (ERCP) before their laparoscopic cholecystectomy. Two patients required laparoscopic choledocha l exploration. The operating time and postoperative hospitalization were si gnificantly longer (P = .0005) in the complicated group when compared with the elective patients. No significant complications such as the need for re operation, injury to the choledocuhus or to other viscera, bile leak, or re tained choledocholithiasis occurred. Conclusions: Laparoscopic cholecystectomy is a safe, effective procedure in children for removal of the gallbladder, The exact role of routine cholang iography and ERCP remains unclear. Copyright (C) 1999 by W.B. Saunders Comp any.