Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing
Background: Laparoscopic cholecystectomy (LC) is the standard of care for gallbladder (GB) pathologies. We evaluated clinical, ultrasonographic (US) data as well as histopathological findings in children affected with symptomatic cholecystic disease (SCD) who underwent LC, with the aim of defining s...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-05-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fped.2020.00203/full |
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| author | Gloria Pelizzo Rossana Bussani Annalisa De Silvestri Marco Di Mitri Gregorio Rosone Salvatore Amoroso Mario Milazzo Vincenza Girgenti Giovanni Battista Mura Elettra Unti Davide Rozze Vennus Shafiei Valeria Calcaterra |
| author_facet | Gloria Pelizzo Rossana Bussani Annalisa De Silvestri Marco Di Mitri Gregorio Rosone Salvatore Amoroso Mario Milazzo Vincenza Girgenti Giovanni Battista Mura Elettra Unti Davide Rozze Vennus Shafiei Valeria Calcaterra |
| author_sort | Gloria Pelizzo |
| collection | DOAJ |
| description | Background: Laparoscopic cholecystectomy (LC) is the standard of care for gallbladder (GB) pathologies. We evaluated clinical, ultrasonographic (US) data as well as histopathological findings in children affected with symptomatic cholecystic disease (SCD) who underwent LC, with the aim of defining surgical timing.Methods: We reviewed our cases who underwent elective LC (ELC) or urgent LC (ULC). Clinical, US, surgical and histological features were used to create different risk scores.Results: We considered 26 children (17 ELC/9 ULC). US signs were not different in the two groups (p > 0.05). Operating times were longer in ELC than in ULC (p = 0.01). Histopathological evaluation revealed fibrosis and atrophy in both ELC and ULC. The clinical risk score was higher in ELC compared to ULC (p < 0.001). An increased operative risk score was noted in patients with systemic inflammatory signs (OR1.98), lithotherapy (OR1.4.3) and wall thickening ≥3 mm (OR2.6). An increased histopathological risk score was detected in children with symptom duration >7 days (OR3.61), concomitant hematological disease (OR1.23) and lithotherapy (OR3.61).Conclusion: Criteria adopted in adults cannot be adopted to detect the severity of GB damage in children. A dedicated clinical and US score is mandatory to define the most appropriate surgical timing. |
| first_indexed | 2024-12-10T06:36:34Z |
| format | Article |
| id | doaj.art-5f94ee2c66b741808204ab6dc83a8ae2 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-10T06:36:34Z |
| publishDate | 2020-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-5f94ee2c66b741808204ab6dc83a8ae22022-12-22T01:58:55ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602020-05-01810.3389/fped.2020.00203537754Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical TimingGloria Pelizzo0Rossana Bussani1Annalisa De Silvestri2Marco Di Mitri3Gregorio Rosone4Salvatore Amoroso5Mario Milazzo6Vincenza Girgenti7Giovanni Battista Mura8Elettra Unti9Davide Rozze10Vennus Shafiei11Valeria Calcaterra12Pediatric Surgery Unit, V. Buzzi Children's Hospital and Department of Biomedical and Clinical Science L. Sacco, University of Milano, Milan, ItalyInstitute of Pathologic Anatomy, University of Trieste, Trieste, ItalyBiometry and Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, ItalyPediatric Surgery Unit, Children's Hospital, ARNAS Civico-Di Cristina-Benfratelli, Palermo, ItalyPediatric Surgery Unit, Children's Hospital, ARNAS Civico-Di Cristina-Benfratelli, Palermo, ItalyPediatric Surgery Unit, Children's Hospital, ARNAS Civico-Di Cristina-Benfratelli, Palermo, ItalyPediatric Surgery Unit, Children's Hospital, ARNAS Civico-Di Cristina-Benfratelli, Palermo, ItalyPediatric Surgery Unit, Children's Hospital, ARNAS Civico-Di Cristina-Benfratelli, Palermo, ItalyPediatric Surgery Unit, Children's Hospital, ARNAS Civico-Di Cristina-Benfratelli, Palermo, ItalyPathology Unit, ARNAS Civico-Di Cristina-Benfratelli, Palermo, ItalyInstitute of Pathologic Anatomy, University of Trieste, Trieste, ItalyInstitute of Pathologic Anatomy, University of Trieste, Trieste, ItalyPediatric Unit, Department of Internal Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, ItalyBackground: Laparoscopic cholecystectomy (LC) is the standard of care for gallbladder (GB) pathologies. We evaluated clinical, ultrasonographic (US) data as well as histopathological findings in children affected with symptomatic cholecystic disease (SCD) who underwent LC, with the aim of defining surgical timing.Methods: We reviewed our cases who underwent elective LC (ELC) or urgent LC (ULC). Clinical, US, surgical and histological features were used to create different risk scores.Results: We considered 26 children (17 ELC/9 ULC). US signs were not different in the two groups (p > 0.05). Operating times were longer in ELC than in ULC (p = 0.01). Histopathological evaluation revealed fibrosis and atrophy in both ELC and ULC. The clinical risk score was higher in ELC compared to ULC (p < 0.001). An increased operative risk score was noted in patients with systemic inflammatory signs (OR1.98), lithotherapy (OR1.4.3) and wall thickening ≥3 mm (OR2.6). An increased histopathological risk score was detected in children with symptom duration >7 days (OR3.61), concomitant hematological disease (OR1.23) and lithotherapy (OR3.61).Conclusion: Criteria adopted in adults cannot be adopted to detect the severity of GB damage in children. A dedicated clinical and US score is mandatory to define the most appropriate surgical timing.https://www.frontiersin.org/article/10.3389/fped.2020.00203/fulllaparoscopiccholecystectomysymptomaticcholecystic diseasechildrensurgical timing |
| spellingShingle | Gloria Pelizzo Rossana Bussani Annalisa De Silvestri Marco Di Mitri Gregorio Rosone Salvatore Amoroso Mario Milazzo Vincenza Girgenti Giovanni Battista Mura Elettra Unti Davide Rozze Vennus Shafiei Valeria Calcaterra Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing Frontiers in Pediatrics laparoscopic cholecystectomy symptomatic cholecystic disease children surgical timing |
| title | Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing |
| title_full | Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing |
| title_fullStr | Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing |
| title_full_unstemmed | Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing |
| title_short | Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing |
| title_sort | laparoscopic cholecystectomy for symptomatic cholecystic disease in children defining surgical timing |
| topic | laparoscopic cholecystectomy symptomatic cholecystic disease children surgical timing |
| url | https://www.frontiersin.org/article/10.3389/fped.2020.00203/full |
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