Biography
Biography: Rajeev Agarwal
Abstract
Symptomatic cholelithiasis surgery in children has increased in tendency over the last 10 years. The frequency of cholelithiasis in children is assessed to range from 0.13 to 1.9% and when compared with the adult population, where risk of cholelithiasis is assessed as 10-15%. Cholecystectomy in children was performed extremely rarely before the era of minimally invasive procedures. They present their experience of treatment of cholelithiasis in children. Laparoscopic cholecystectomy was performed using the three ports technique. Laparoscopic cholecystectomy is routine surgical procedure in non-complicated cases when concernments are located in gallbladder, but in the cases of cholodocholithiasis or complications of cholelithiasis as: cholecystitis, hydrops of the gallbladder and biliary pancreatitis algorithms of treatment are different. The pediatric surgical units which treat those conditions should be prepared to manage all that complications. The experience of pediatric gastroenterologist’s in endoscopic retrograde cholangiopancreatography (ERCP) is limited and in many times cooperation with adult gastroenterologist or experienced pediatric units are crucial. Between 2011 and 2017, 149 laparoscopic cholecystectomies were performed in their center. In 98 patients, elective LC was performed. In 32 patients with biliary colic LC was performed after resolution of symptoms during the same admission. In nine patient’s cholecystitis and in three hydrops of gallbladder were recognized. In five patients choledocholithias required ERCP procedure before cholecystectomy and in two patient’s biliary pancreatitis was connected with cholelithiasis. All patients had performed LC using three port techniques. There were no intraoperative complications demanding reoperation such as injury to the choledochus or other viscera, bile leakage or bleeding. The time of hospitalization ranged from 2 days to 21 days (average 4.5 days). The treatment of cholelithiasis should be performed in pediatric surgical units which have experience in laparoscopic procedures and are able to treat complicated cases especially when choledocholithiasis is suspected. In experienced hands the laparoscopic three ports technique is safe procedure connected with minimal rate of complications.