Complications of cholelithiasis in children as indications for emergency surgery

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND: Cholelithiasis in children is a relatively rare disease; however, its incidence is increasing. Consequently, the absolute number of complicated forms may also rise.

AIM: The work aimed to analyze the clinical course and outcomes of treatment of uncomplicated and complicated forms of cholelithiasis in children.

METHODS: This retrospective study included 53 children treated between 2019 and 2024. Patients were divided into two groups: group 1 comprised 40 children (75.5%) who underwent laparoscopic cholecystectomy for uncomplicated cholelithiasis; group 2 comprised 13 children (24.5%) with complicated cholelithiasis, who, in addition to standard laparoscopic cholecystectomy, underwent various types of common bile duct exploration.

RESULTS: The distribution of complications in group 2 was as follows: 4 (30.8%) cases of acute cholecystitis, 2 (15.4%) of acute pancreatitis, 6 (46.1%) of choledocholithiasis, and 1 (7.7%) case of spontaneous perforation of the common bile duct. Types of emergency cholecystectomy in group 2 included: 6 (46.1%) laparoscopic cholecystectomies; 4 (30.8%) cases of laparotomy with cholecystectomy, choledochotomy, choledocholithoextraction, and drainage of the common bile duct through the cystic duct stump; 1 (7.7%) laparotomy with cholecystectomy, choledochotomy, choledocholithoextraction, papillosphincterotomy, and drainage of the common bile duct through the cystic duct stump; and 2 (15.4%) endoscopic retrograde cholangiopancreatographies with papillosphincterotomy followed by delayed laparoscopic cholecystectomy. The median operative time was significantly shorter in group 1 than in group 2: 67.5 [55.0; 85.0] minutes versus 150.0 [85.0; 190.0] minutes, respectively (р=1,0×10–7). The total length of hospital stay after surgery was also significantly shorter in group 1 than in group 2 (p=1,0×10–8). Median values were 3.0 [2.0; 4.0] days in group 1 and 14.0 [12.0; 16.0] days in group 2.

CONCLUSION: Diagnosis and treatment of complicated cholelithiasis in children are challenging. Its rarity makes the development of optimal therapeutic approaches particularly demanding. Endoscopic retrograde cholangiopancreatography with papillosphincterotomy is a safe and effective treatment option, though further clinical experience is needed to support its widespread use.

Full Text

Restricted Access

About the authors

Pavel M. Pavlushin

State Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University

Author for correspondence.
Email: pavlushinpav@mail.ru
ORCID iD: 0000-0002-6684-5423
SPIN-code: 6893-6854
Россия, Novosibirsk; Novosibirsk

Аleksandra А. Mironova

Novosibirsk State Medical University

Email: mironova_a_a99@mail.ru
ORCID iD: 0009-0007-1053-3168
SPIN-code: 2634-4239
Россия, Novosibirsk

Aleksei V. Gramzin

State Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University

Email: dxo-26@yandex.ru
ORCID iD: 0000-0001-7338-7275
SPIN-code: 9818-3830

MD, Cand. Sci. (Medicine)

Россия, Novosibirsk; Novosibirsk

Evgenii A. Drobyazgin

State Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University

Email: evgenyidrob@inbox.ru
ORCID iD: 0000-0002-3690-1316
SPIN-code: 4665-2278

MD, Dr. Sci. (Medicine), Professor

Россия, Novosibirsk; Novosibirsk

Mikhail A. Akselrov

Tyumen State Medical University

Email: akselerov@mail.ru
ORCID iD: 0000-0001-6814-8894
SPIN-code: 3127-9804

MD, Dr. Sci. (Medicine), Professor

Россия, Tyumen

Ivan A. Porshennikov

State Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University

Email: porshennikov@oblmed.nsk.ru
ORCID iD: 0000-0002-6969-6865
SPIN-code: 7291-7988

MD, Cand. Sci. (Medicine), Assistant Professor

Россия, Novosibirsk; Novosibirsk

Gennadii N. Tolstykh

State Novosibirsk Regional Clinical Hospital

Email: tolstykh.gennadiy.57@mail.ru
ORCID iD: 0009-0005-7883-7999
SPIN-code: 2874-2547

MD, Cand. Sci. (Medicine)

Россия, Novosibirsk

Vladislav N. Tsyganok

State Novosibirsk Regional Clinical Hospital

Email: vlad1kksu@gmail.com
ORCID iD: 0000-0003-1176-6741
SPIN-code: 7536-5976
Россия, Novosibirsk

Yurii Yu. Koinov

State Novosibirsk Regional Clinical Hospital

Email: doctor2012@inbox.ru
ORCID iD: 0000-0002-9528-0601
SPIN-code: 6650-7710
Россия, Novosibirsk

Artem A. Tratonin

State Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University

Email: artem7496@mail.ru
ORCID iD: 0000-0001-8457-9731
SPIN-code: 2786-4101
Россия, Novosibirsk; Novosibirsk

Аleksandra А. Okhotina

State Novosibirsk Regional Clinical Hospital

Email: mariam108@yandex.ru
ORCID iD: 0000-0002-1433-4760
SPIN-code: 3133-2809
Россия, Novosibirsk

Artur A. Glazkov

State Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University

Email: dr.glazkov.artur@yandex.ru
ORCID iD: 0000-0002-4964-6860
SPIN-code: 6573-9994
Россия, Novosibirsk; Novosibirsk

Anna B. Nikulina

State Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University

Email: lyatyaska@mail.ru
ORCID iD: 0000-0002-7199-2161
SPIN-code: 2937-0361
Россия, Novosibirsk; Novosibirsk

Pavel V. Trushin

State Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University

Email: tpv1974@rambler.ru
ORCID iD: 0000-0002-5251-8851
SPIN-code: 1168-7317

MD, Dr. Sci. (Medicine), Assistant Professor

Россия, Novosibirsk; Novosibirsk

Yurii V. Chikinev

State Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University

Email: chikinev@inbox.ru
ORCID iD: 0000-0002-6795-6678
SPIN-code: 9782-1047

MD, Dr. Sci. (Medicine), Professor

Россия, Novosibirsk; Novosibirsk

References

  1. Poddar U. Gallstone disease in children. Indian Pediatr. 2010;47(11):945–953. doi: 10.1007/s13312-010-0159-2
  2. Chamorro CC, Arteaga P, Paredes C, et al. Cholelithiasis and associated complications in pediatric patients. Cir Pediatr. 2020;33(4):172–176.
  3. Dumova NB, Luppova NE, Privorotsky VF, et al. Gallstone disease in children: modern concepts, treatment options and prevention. Gastroenterology of Saint Petersburg. 2008;(1):25–30. (In Russ.) EDN: BJLATE
  4. Pavlushin PM, Porshennikov IA, Pavlik VN, et al. Spontaneous biliary perforation in a child: case report and review. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):505–512. (In Russ.) doi: 10.17816/psaic1285 EDN: KQQKHQ
  5. Tsai J, Sulkowski JP, Cooper JN, et al. Sensitivity and predictive value of ultrasound in pediatric cholecystitis. J Surg Res. 2013;184(1):378–382. doi: 10.1016/j.jss.2013.03.066
  6. Esposito C, Corcione F, Settimi A, et al. Twenty-five year experience with laparoscopic cholecystectomy in the pediatric population-from 10 mm clips to indocyanine green fluorescence technology: long-term results and technical considerations. J Laparoendosc Adv Surg Tech A. 2019;29(9):1185–1191. doi: 10.1089/lap.2019.0254
  7. Frolov PA, Korotkevich AG, Pavlenko VV, et al. Prevention of acute post-manipulation pancreatitis. Experimental and Clinical Gastroenterology. 2023;(5):114–121. doi: 10.31146/1682-8658-ecg-213-5-114-121 EDN: APZLOC
  8. Bordakov VN, Reutskij IP, Bordakov PV. Modern methods of diagnostics choledocholithiasis. Military medicine. 2014;(3):94–101. (In Russ.) EDN: SLQPSL
  9. Akselrov MA, Kokotalkin AV, Shvetsov VA. Calculous cholecystitis in children. New technologies to help surgeons. Health. Medical ecology. Science. 2019;(1):50–51. (In Russ.) doi: 10.5281/zenodo.824222 EDN: ZDHZZR
  10. Androsyuck AG, Zotin AV. Complications of cholelithiasis in children. In: Kovalenko LV, Bolotskaya LA, Bubovich EV, et al editors. Proceedings of the III all-Russian science and practice conferences: Fundamental and applied problems of human health preservation in the North; Surgut, 20–21 Oct 2018. Surgut; 2018. P. 173–178. (In Russ.) EDN: YRLTWH
  11. Wilson P, Leese T, Morgan WP, et al. Elective laparoscopic cholecystectomy for “all-comers”. Lancet. 1991;338(8770):795–797. doi: 10.1016/0140-6736(91)90674-e
  12. Johansson M, Thune A, Blomqvist A, et al. Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg. 2003;7(5):642–645. doi: 10.1016/s1091-255x(03)00065-9
  13. Kolla SB, Aggarwal S, Kumar A, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc. 2004;18(9):1323–1327. doi: 10.1007/s00464-003-9230-6
  14. Badru F, Saxena S, Breeden R, et al. Optimal timing of cholecystectomy in children with gallstone pancreatitis. J Surg Res. 2017;215(718):225–230. doi: 10.1016/j.jss.2017.03.045
  15. Lowe ME, Greer JB. Pancreatitis in children and adolescents. Curr Gastroenterol Rep. 2008;10(2):128–135. doi: 10.1007/s11894-008-0033-8
  16. Sarrami M, Ridley W, Nightingale S, et al. Adolescent gallstones-need for early intervention in symptomatic idiopathic gallstones. Pediatr Surg Int. 2019;35(3):569–574. doi: 10.1007/s00383-019-04461-w
  17. Melekhina OV, Sokolov YY, Efremenkov AM, et al. Percutaneous transhepatic cholangiostomy in children. Russian Journal of Pediatric Surgery. 2023;27(5):331–337. (In Russ.) doi: 10.55308/1560-9510-2023-27-5-331-337 EDN: UMYEMP
  18. Lee T, Teng TZJ, Shelat VG. Choledochoscopy: An update. World J Gastrointest Endosc. 2021;13(12):571–592. doi: 10.4253/wjge.v13.i12.571
  19. Felux J, Sturm E, Busch A, et al. ERCP in infants, children and adolescents is feasible and safe: results from a tertiary care center. United Eur Gastroenterol J. 2017;5(7):1024–1029. doi: 10.1177/2050640616687868
  20. Issa H, Al-Haddad A, Al-Salem AH. Diagnostic and therapeutic ERCP in the pediatric age group. Pediatr Surg. 2007;23:111–116. doi: 10.1007/s00383-006-1832-3
  21. Zhou X-D, Chen Q-F, Zhang Y-Y, et al. Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones. World J Gastroenterol. 2019;25(4):485–497. doi: 10.3748/wjg.v25.i4.485
  22. Krasilnikov DM, Safin RS, Vasil’ev DZ, et al. Prevention of complications after endoscopic retrograde cholangiopancreatography and papillosphincterotomy. Kazan medical journal. 2012;93(4):597–601. (In Russ.) doi: 10.17816/KMJ1551 EDN: PARJXF

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Trend in the number of surgical interventions by year.

Download (58KB)
Indexing metadata
3. Fig. 2. Endoscopic retrograde cholangiopancreatography, papillosphincterotomy, and lithoextraction.

Download (127KB)
Indexing metadata
4. Fig. 3. Intraoperative cholangiography through the cystic duct stump.

Download (143KB)
Indexing metadata
5. Fig. 4. Comparison of operative time. LCE, laparoscopic cholecystectomy; ECE, emergency cholecystectomy.

Download (63KB)
Indexing metadata
6. Fig. 5. Comparison of length of hospital stay. LCE, laparoscopic cholecystectomy; ECE, emergency cholecystectomy.

Download (58KB)
Indexing metadata

Copyright (c) 2025 Eco-Vector

License URL: https://eco-vector.com/for_authors.php#07
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: ПИ № ФС 77 - 81892 от 24.09.2021 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies