Outcome after laparoscopic cholecystotomy and cholecystectomy in children with symptomatic cholecystollithiasis: a preliminary report

Laparoscopic cholecystectomy (LCE) has become the procedure of choice for s ymptomatic gallstones in children. However, there is concern about the disa dvantages of cholecystectomy. Numerous postoperative symptoms and a possibl e correlation of the procedure with a higher incidence of right-sided colon carcinoma have been described. Therefore, it has been suggested to remove the gallstones via a cholecystotomy, leaving the gallbladder in place. This is the first report on the functional and symptomatic outcome of laparosco pic cholecystotomy (LCO) versus LCE in a consecutive series of children. A follow-up study of all children who underwent surgery for symptomatic galls tone disease from 1993 to 1999 was performed. Nine underwent LCO and 8 stan dard LCE. The procedure was chosen according to the preference of the surge on. Patients and parents underwent a standardized follow-up interview. The intensitiy of six gastrointestinal symptoms was graded from 0 to 3. The pat ients and parents scored the symptomatic outcome using a 100-point visual a nalogue scale. There were no intraoperative complications. Bleeding of a po rt site required suturing in I patient after LCO, and fever with a further uneventful course occurred in another after LCE. The mean duration of hospi tal stay was 3.0 days after LCO and 2.4 days after LCE, In I patient a miss ed gallstone was identified 4 weeks after LCO. The patient underwent LCE wi th a further uneventful course. At follow-up (mean 20.7 months after LCO, 2 8.3 months after LCE, P = n.s.) there was a tendency toward a lower inciden ce of symptoms after LCO. Symptoms were reported by 3 of 8 patients after L CO and 5 of 8 after LCE. The mean score of the symptomatic outcome was not statistically different. All patients with LCO were free of stones on ultra sound examination with normal contraction of the gallbladder. LCO thus repr esents an alternative approach. We consider LCO for children with symptomat ic cholecystolithiasis before the onset of puberty. However, data on the lo ng-term outcome from larger series are mandatory before a general recommend ation can be given.