Laparoscopic Cholecystectomy in Children: The Experience of Two Centers Focusing on Indications and Timing in the Era of “New Technologies”
Francesca Destro,
Ugo Maria Pierucci,
Eleonora Durante,
Anna Maria Caruso,
Vincenza Girgenti,
Carlotta Paola Maria Canonica,
Irene Degrassi,
Alessandro Campari,
Alessandro Pellegrinelli,
Marta Barisella,
Manuela Nebuloni,
Marco Brunero,
Elia Mario Biganzoli,
Valeria Calcaterra,
Gloria Pelizzo
Affiliations
Francesca Destro
Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy
Ugo Maria Pierucci
Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy
Eleonora Durante
Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy
Anna Maria Caruso
Pediatric Surgery Unit, Children’s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
Vincenza Girgenti
Pediatric Surgery Unit, Children’s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
Carlotta Paola Maria Canonica
Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy
Irene Degrassi
Department of Pediatrics, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy
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
Marta Barisella
Pathology Unit, Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
Manuela Nebuloni
Pathology Unit, Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
Marco Brunero
Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy
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
Gloria Pelizzo
Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy
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.
