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Destro F, Pierucci UM, Durante E, Caruso AM, Girgenti V, Canonica CPM, Degrassi I, Campari A, Pellegrinelli A, Barisella M, Nebuloni M, Brunero M, Biganzoli EM, Calcaterra V, Pelizzo G. Laparoscopic Cholecystectomy in Children: The Experience of Two Centers Focusing on Indications and Timing in the Era of "New Technologies". CHILDREN (BASEL, SWITZERLAND) 2023; 10:1771. [PMID: 38002862 PMCID: PMC10670818 DOI: 10.3390/children10111771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND In children, laparoscopic cholecystectomy (LC) is now considered the gold standard for gallbladder (GB) removal. In the past, hemolytic disorders associated with cholelithiasis represented the most frequent conditions requiring LC; this is being overtaken by cholelithiasis and biliary conditions in overweight or ex-premature children. AIMS This study aims to describe current indications and timing for LC in pediatric patients. METHODS Retrospective study. Data on previous medical therapy, ultrasound, pre- and intraoperative aspects, and histology were collected for patients treated in 2020-2023. RESULTS In total, 45 patients were enrolled: 15 who underwent urgent surgery and 30 electives. Groups differed in terms of obesity rate, symptoms, ultrasound features, and intraoperative status. The most relevant risk factors for surgical complexity were age and pubertal stage, elevated cholestasis indexes, and gallbladder wall thickness > 3 mm at ultrasound. GB wall thickening ≥3 mm, US Murphy sign, fluid collections, and gallbladder distention on ultrasound correlated with high surgical scores. CONCLUSIONS Indications for laparoscopic cholecystectomy in children seem to evolve caused by changing characteristics of the pediatric population. Patients with overweight/obesity may develop more complex GB diseases. Asymptomatic patients should be considered for surgery after observation, considering age and/or pubertal maturation when other risk factors are absent.
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Affiliation(s)
- Francesca Destro
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (U.M.P.); (E.D.); (C.P.M.C.); (M.B.)
| | - Ugo Maria Pierucci
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (U.M.P.); (E.D.); (C.P.M.C.); (M.B.)
| | - Eleonora Durante
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (U.M.P.); (E.D.); (C.P.M.C.); (M.B.)
| | - Anna Maria Caruso
- Pediatric Surgery Unit, Children’s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy; (A.M.C.); (V.G.)
| | - Vincenza Girgenti
- Pediatric Surgery Unit, Children’s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy; (A.M.C.); (V.G.)
| | - Carlotta Paola Maria Canonica
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (U.M.P.); (E.D.); (C.P.M.C.); (M.B.)
| | - Irene Degrassi
- Department of Pediatrics, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (I.D.); (V.C.)
| | - Alessandro Campari
- Department of Pediatric Radiology, Buzzi Children’s Hospital, 20154 Milan, Italy;
| | - Alessandro Pellegrinelli
- Pathology Unit, Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.P.); (M.B.); (M.N.)
| | - Marta Barisella
- Pathology Unit, Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.P.); (M.B.); (M.N.)
| | - Manuela Nebuloni
- Pathology Unit, Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.P.); (M.B.); (M.N.)
| | - Marco Brunero
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (U.M.P.); (E.D.); (C.P.M.C.); (M.B.)
| | - Elia Mario Biganzoli
- Department of Biomedical and Clinical Sciences (DIBIC) & Data Science Research Center (DSRC), Unit of Clinical Research and Medical Statistics, Ospedale “L. Sacco” LITA Campus, University of Milan, 20122 Milan, Italy;
| | - Valeria Calcaterra
- Department of Pediatrics, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (I.D.); (V.C.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Gloria Pelizzo
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (U.M.P.); (E.D.); (C.P.M.C.); (M.B.)
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy
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Krawczyk M, Kułaga Z, Niewiadomska O, Jankowska I, Lebensztejn D, Więcek S, Socha P. Are children with gallstone disease more overweight? Results of a matched case-control analysis. Clin Res Hepatol Gastroenterol 2023; 47:102204. [PMID: 37678608 DOI: 10.1016/j.clinre.2023.102204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Gallstone disease (GD) is increasingly common among children, possibly caused by an unhealthy food environment and the associated unhealthy lifestyle. In this study, we investigate the association between body weight and gallstone risk in a cohort of prospectively recruited children with GD. METHODS We analysed 188 children with gallstones (50.0% girls, median age 9.8 years) and 376 children without stones who were age- and gender-matched to cases in a ratio of 2:1. Cases were prospectively recruited at three Polish university centres (Warsaw, Katowice and Bialystok). Gallstones were diagnosed by either abdominal sonography or by a history of cholecystectomy. Matched controls without gallstones were selected from 22,412 children taking part in nationally representative Polish health surveys (OLA and OLAF studies) which provided height and weight data for randomly selected pre-school (2.5-6 years) and school aged (7-18 years) children and adolescents. RESULTS Analysis of the age- and gender-matched cases and controls demonstrated that patients with GD had significantly higher BMI (P = 0.02) and BMI z-score (P < 0.01) than children without stones. Children with gallstones were more frequently overweight (35.6%, P < 0.01) and obese (12.2%, P < 0.01) than controls (18.4% and 6.7%, respectively). Regression analyses showed that BMI, BMI z-score, overweight and obesity were all associated with increased GD risk (all P < 0.05). CONCLUSIONS Overweight and obesity are common in children with cholelithiasis. Given the epidemic of obesity in children we should expect an increasing prevalence of gallstones and stone-related complications in youths and in adults.
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Affiliation(s)
- Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Kirrberger Str. 100, Homburg 66421, Germany; Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - Zbigniew Kułaga
- Public Health Department of the Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730, Warsaw, Poland.
| | - Olga Niewiadomska
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Irena Jankowska
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dariusz Lebensztejn
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, Bialystok, Poland
| | - Sabina Więcek
- Department of Pediatrics, Silesian Medical Academy, Katowice, Poland
| | - Piotr Socha
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
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Pogorelić Z, Lovrić M, Jukić M, Perko Z. The Laparoscopic Cholecystectomy and Common Bile Duct Exploration: A Single-Step Treatment of Pediatric Cholelithiasis and Choledocholithiasis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101583. [PMID: 36291520 PMCID: PMC9601212 DOI: 10.3390/children9101583] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND In recent years, complicated biliary tract diseases are increasingly diagnosed in children. Laparoscopic exploration of the common bile duct (LCBDE) followed by laparoscopic cholecystectomy has gained popularity in children. The aim of this study was to investigate the outcomes of LCBDE in children and compare them with the treatment outcomes of previously used endoscopic retrograde cholangiopancreatography (ERCP). METHODS From January 2000 to January 2022, a total of 84 children (78.5% female) underwent laparoscopic cholecystectomy with a median follow-up of 11.4 (IQR 8, 14) years. Of these, 6 children underwent laparoscopic cholecystectomy (LC) + ERCP and 14 children underwent LCBDE for choledochiothiasis. The primary end point of the study was the success of treatment in terms of the incidence of complications, recurrence rate, and rate of reoperation. Secondary endpoints were stone characteristics, presenting symptoms, duration of surgery, and length of hospital stay. RESULTS The majority of patients were female in both groups (83.5% vs. 85.7%), mostly overweight with a median BMI of 27.9 kg/m2 and 27.4 kg/m2, respectively. Obstructive jaundice, colicky pain, acute pancreatitis, and obstruction of the papilla were the most common symptoms in both groups. The majority of patients (68%) had one stone, whereas two or more stones were found in 32% of patients. The median diameter of the common bile duct was 9 mm in both groups. The procedure was successfully completed in all patients in the ERCP group. In the group of patients treated with LCBDE, endoscopic extraction of the stone with a Dormia basket was successfully performed in ten patients (71.4%), while in the remaining four patients (28.6%) the stones were fragmented with a laser because extraction with the Dormia basket was not possible. The median operative time was 79 min in the LCBDE group (IQR 68, 98), while it was slightly longer in the ERCP group, 85 min (IQR 74, 105) (p = 0.125). The length of hospital stay was significantly shorter in the LCBDE group (2 vs. 4 days, p = 0.011). No complications occurred in the LCBDE group, while two (40%) complications occurred in the ERCP group: pancreatitis and cholangitis (p = 0.078). During the follow-up period, no conversions, papillotomies, or recurrences were recorded in either group. CONCLUSIONS Exploration of the common bile duct and removal of stones by LCBDE is safe and feasible in pediatric patients for the treatment of choledocholithiasis. Through this procedure, choledocholithiasis and cholelithiasis can be treated in a single procedure without papillotomy or fluoroscopy. Compared with LC + ERCP, LCBDE is associated with a shorter hospital stay. The incidence of complications was rather low but not statistically significant.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia
- Department of Surgery, School of Medicine, University of Split, Šoltanska 2, 21 000 Split, Croatia
- Correspondence: ; Tel.: +385-21556654
| | - Marko Lovrić
- Department of Surgery, School of Medicine, University of Split, Šoltanska 2, 21 000 Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia
- Department of Surgery, School of Medicine, University of Split, Šoltanska 2, 21 000 Split, Croatia
| | - Zdravko Perko
- Department of Surgery, School of Medicine, University of Split, Šoltanska 2, 21 000 Split, Croatia
- Department of Surgery, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia
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