Laparoscopic Cholecystectomy in Children: A Report on 114 Consecutive Cases

OBJECTIVES: Since pediatric cholelithiasis is uncommon, to date there have not been any large series reporting the results of laparoscopic cholecystectomy performed in children. However, at our institution, the combination of an early commitment to laparoscopic techniques for children and access to a large population of pediatric patients with sickle cell disease have provided a significant experience with laparoscopic cholecystectomy in children. This report reviews that experience. METHODS AND PROCEDURES: The charts of all patients on the pediatric surgical service who underwent attempted laparoscopic cholecystectomy were reviewed. Data were abstracted pertaining to clinical history, diagnosis, operative technique, length of hospital stay, postoperative complications and long-term outcome. Umbilical Hasson trocar placement with three additional trocars, along with cholangiography through the gallbladder, was the operative technique utilized. METHODS AND RESULTS: From December 1990 through October 1997, laparoscopic cholecystectomy was attempted in 114 patients, ranging in age from 6 months to 23 years (mean 12.3 years). Hemolysis from sickle cell disease was the predominant etiology, occurring in 83 patients (73%). Ninety patients (80%) presented with cholelithiasis, 21 (18.2%) with choledocholithiasis, and only two (1.8%) with acute cholecystitis. Only 3 patients (2.6%) required conversion to open cholecystectomy: one due to massive hepatomegaly, one due to a very short cystic duct and the third due to the patient's small size (6 months old) early in our series. One patient underwent reexploration for intra-abdominal bleeding following laparoscopic cholecystectomy, and no patient suffered a bile duct injury or required management of a biloma. Postoperative length of stay average was 2.5 days, with 80% of patients discharged within 48 hours. Significant postoperative complications included a retained common bile duct stone noted four months postoperatively (which was successfully removed endoscopically) and one trocar site hernia in a child with cystic fibrosis. Three children expired (2.6%), but their deaths were not related to their biliary tract surgery. CONCLUSIONS: This report represents the largest series of laparoscopic cholecystectomy in children to date. It confirms that this operation can be performed safely in children of all ages with avoidance of bile duct injuries and should be considered the gold standard in the management of pediatric cholelithiasis and choledocholithiasis.