Complications in pediatric laparoscopic cholecystectomy: systematic review
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REVIEW ARTICLE
Complications in pediatric laparoscopic cholecystectomy: systematic review Karina Miura da Costa1,2 · Amulya Kumar Saxena1 Received: 26 June 2020 / Accepted: 7 September 2020 © Italian Society of Surgery (SIC) 2020
Abstract Laparoscopic cholecystectomy (LC) is the gold standard for surgical management in symptomatic children, but it is not without complications, bile duct injury being among the most feared. This study reviewed the complications of LC in children. MEDLINE/PubMed, CENTRAL and Lilacs were reviewed for LC. Studies in patients ≤ 18 years of age published in English, Portuguese or Spanish were selected by two independent reviewers. Data were collected for patients’ characteristics, surgical information, complications, mortality and follow-up. Twenty-four papers were identified and offered 2783 patients. Mean age was 11 years (3 months–18 years). In the 93/2783 (3.3%) complications, single-port procedures were associated with seven (7.5%), 3/4-port with 81 (87.1%) and the number of ports were not specified in five. Routine cholangiography was not part of the protocol in any of the reports. Complications included wound issues (n = 24), perforation (n = 14), bleeds (n = 13), biliary tree complications (n = 9), sickle cell crisis (n = 8), fever (n = 6), leaks (n = 4), pain (n = 3), nausea/emesis (n = 3) and others (n = 9). Two of these patients had a history of obesity and cholecystitis and only two biliary tree lesions were diagnosed intra-operatively. Seventeen cases (18.3%) required re-intervention: 15 surgical and two endoscopic. Issues related to biliary tree included: common bile duct lesion (n = 6), biliary fistula (n = 3), clip dislocation from cystic duct (n = 1), cholangitis (n = 1) and calculus (n = 1). There was no mortality, and the mean follow-up period was 10.3 months (1 month–5 years). LC is safe in children and, although most complications are minor, almost 1/5 complications require interventions, mostly due to bleeding and biliary tree complications. Mortality has not been reported in pediatric LC. Keywords Pediatric · Cholecystectomy · Cholelithiasis · Laparoscopy · Postoperative complications
Introduction Cholelithiasis has been considered to be uncommon in children, however, this diagnosis has undoubtedly increased in this age group, particularly in the absence of hemolytic disease, and the cause is believed to be multifactorial [1–5]. Laparoscopic cholecystectomy (LC) is the gold standard for surgical management in symptomatic children, but it is not without complications, among them bile duct injury being * Amulya Kumar Saxena [email protected] 1
Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London SW10 9NH, UK
Department of Biological and Health Sciences, University Center of Maringá, Guedner Avenue, Maringa, Parana 1610, Brazil
2
the most severe as reported in 0.44% of patients younger than 20 years of age [1, 4, 6–8]. Nevertheless, ther
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