Management of childhood cholelithiasis: experience at a third-level pediatric surgical center

Abstract

Background: Cholelithiasis is increasing in the pediatric population. While its etiology is primarily idiopathic, it is often related to underlying diseases, and a significant number of patients may be asymptomatic. There are currently no guidelines for the management of asymptomatic patients with both cholelithiasis and a predisposing condition. Therefore, this study seeks to highlight situations where prophylactic cholecystectomy may be desirable based on pre, intra, and postoperative complications, length of hospital stay, and disease recurrence. Methods: We retrospectively reviewed the medical records of patients who underwent elective laparoscopic cholecystectomy between October 2011 and September 2022. Data, including clinical presentation at the time of diagnosis and admission, imaging, treatments, complications, and length of hospital stay, were collected. Results: Thirty-two patients (21 females and 11 males) were included in the study. The median age was 14 years (range <1–17). Five different groups of patients were identified based on associated pathologies. Ten patients had hematologic disease (31.25%), four had cystic fibrosis (12.5%), six were overweight or obese (18.75%), two had an autoimmune disease (6.25%), and ten had no underlying disease (31.25%). Twenty-six patients were symptomatic (81.25%), and six were asymptomatic (18.75%). The idiopathic etiology group was entirely symptomatic. All patients underwent a laparoscopic cholecystectomy. There was one patient (in the idiopathic etiology group) who required conversion from laparoscopy to open surgery and a reintervention (3.13%). Hematologic and cystic fibrosis patients with asymptomatic cholelithiasis had a shorter length of hospital stay than patients with the same condition who progressed from asymptomatic to symptomatic gallstone disease. Conclusions: Patients with cystic fibrosis and hematologic diseases who have concomitant asymptomatic cholelithiasis may benefit from early laparoscopic cholecystectomy, which could reduce the probability of surgical and postsurgical complications and shorten the length of hospital stays.