Feasibility of Three Ports Laparoscopic Cholecystectomy in Pediatric Patients


Pierre Jean Aurelus, Nestor Cuauhtémoc *

Received Date: 00--0000 Accepted Date: 00--0000 Published Date: 00--0000

Citation: Feasibility of Three Ports Laparoscopic Cholecystectomy in Pediatric Patients. American Research Journal of Pediatrics. 2017; 1(1): 1-6

Copyright This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited


Abstract:

Introduction:

The standard surgical procedure for treating benign gallbladder disease is the cholecystectomy. However there are few reports in the literature over laparoscopic cholecystectomy in pediatric population.1, 2 The aim of this work was to report, retrospectively, the perioperative outcomes of this procedure to value the feasibility on three ports laparoscopic cholecystectomy in pediatric patient.

Patients and Methods:

44 consecutive patients with advanced gallbladder disease were referred in our center (HP: CMNSXXI, IMSS) for laparoscopic cholecystectomy. Data were accrued retrospectively regarding: age, gender, indications for laparoscopic cholecystectomy, peritoneal cavity access, operative time, complications, postoperative length stay and requirement to modify port number. All statistical analyses were performed using the Statistical Package for the Social Sciences version 21.0(SPSS). Significance statistical was determined at p<0.05.

Results:

Data extracted for this review, included a total of 44 infants. From them, the mean patient age was 12.09 years (range: 2-17), male patients comprised 29.5% (n=13) and female patients comprised 70.45 % (n=31) of all patients. Acute cholecystitis was the indication for surgical cholecystectomy in 81.8 %( n=36) of the patients. The operative time had a median of 176 min, there was no bleeding during and after the procedure, 2 patients had bile injury.

Conclusion: The three port laparoscopic cholecystectomy in pediatric population same feasible technically and the outcome of three ports laparoscopic cholecystectomy do not have increased risk of complications during and after the procedure.

KeyWords: Three Ports, Laparoscopic-Cholecystectomy, Pediatric-Patients


Description:

INTRODUCTION

Currently, the standard surgical procedure for treating benign gallbladder disease is the laparoscopic cholecystectomy; however there are few reports in the literature over pediatric population.1,2 From the first laparoscopic cholecystectomy in 1987 until the present, continuously surgeons have perfected this procedure in adult population. Actually, this is a common surgical procedure in adults and in the other hand, it is relatively uncommon in children.3,4 So many studies of different centers purposely reported the effort of surgeons group to reduce the number of port in this procedure: like it was in the Cala report, reduced the standard of four ports( Trocars) to three ports, as did Slim et al.1,4,5The advantages of this procedure include decreased scarring, decreased incisional pain, shorter hospitalization and faster functional recovery.1,4,5In fact, despite its minimally invasive nature, laparoscopic cholecystectomy frequently results in moderate to severe pain during the postoperative period.6 In the same sense, in attempt to reduce the morbidity and offer the benefit of laparoscopic cholecystectomy in our pediatric population, we reduced the number of four ports to three ports. Our aim was to evaluate the results of a retrospective study in the perioperative outcomes to value the feasibility on three ports laparoscopic cholecystectomy in infants. This work was performed in our pediatric center references (Hospital de Pediatría Centro Médico Nacional Siglo XXI “IMSS”/México).

PATIENTS AND METHODS

Between April 2009 to December 2015, 44 consecutive patients with advanced gallbladder disease were referred in our center for laparoscopic cholecystectomy. Those procedures were performed in younger age (<18 years old) by using: one 5 mm port and two 10-12mm ports. Data were accrued retrospectively regarding: age, gender, indications for laparoscopic cholecystectomy, peritoneal cavity access, operative time, complications, postoperative length stay and requirement to modify port number. All statistical analyses were performed using the Statistical Package for the Social Sciences version 21.0(SPSS). Significance statistical was determined at p<0.05.

Technique

Underwent balanced general anesthesia, the patient was placed in trendelenburg position. Through an inferior umbilical incision was inserted a 10-mm port, a 5–mm port was inserted in the right middle-clavicular line upper the umbilical and another 10-mm port was placed in the left side in the middle clavicular line upper umbilical, figures (1,2). The abdomen was insufflated to 8-10 mmHg a 10 mm laparoscope was introduced, figure (3).

The patient was rotated placed in left side position. The first step in the surgical technique was to expose Calot’s triangle and isolate the cystic duct with a blunt dissection. Grasping Hartman´s pouch with a 5-mm grasping double-actions forceps through the sub costal port to performed a reverse triangle and maintaining traction toward the patient´s right foot, the surgeon identify the calot´s triangle by dissected the hepatoduodenal ligament and the cystic duct. We placed two clips in the distal cystic and one clip in the proximal cystic duct with previous dissected and clipping the cystic artery. The gallbladder was removed by using harmonic ultrasound dissected, figure (4).

RESULTS

Data extracted for this review, included a total of 44 infants who underwent laparoscopic cholecystectomy during this period were subject of this study. From them, the mean patient age was 12.09 years (range: 2-17), male patients comprised 29.5% (n=13) and female patients comprised 70.45 % (n=31) of all patients. Although Acute cholecystitis was the indication for surgical cholecystectomy in 81.8% (n=36) of the patients, calculous cholecystitis was in 16 % (n=7) and bile dyskinesia 2.27 %( n=1) of the patients. In the table 1, we observed a summary of comparisons in patient demographic and preoperative clinical indication for the surgical procedure.
And in the table 2, we reported the complications observed during the trans-operatory and the post-operative outcomes of those patients. The operative time had a median of 176 min, there was no bleeding during and after the procedure, 2 patients had bile injury. Abdominal pain had not severely after the operation referred with VAS Score. Two patients (bile injuries) had fever 24 hours after the performed the procedure and 42 patients were discharge at 2 days hospitalized. Two patients were performed an Y by Roux and biliodigestive anastomosis secondary to bile duct injury and required more than 5 days of hospital stays. The procedure was converted in those two patients due to bile injury.