With the increase in indications for cholecystectomy in children, the frequency of laparoscopic cholecystectomy procedures and related problems has increased. The Critical View of Safety (CVS) is the target-specific method for identifying the cystic duct during laparoscopic cholecystectomy to prevent common bile duct injury. We hypothesize that the use of CVS is reliable in the pediatric population.
Data of 91 patients under 18 years of age who underwent elective laparoscopic cholecystectomy were retrospectively analyzed. Patients were divided into two groups depending on whether CVS was applied. The descriptive characteristics and complications of the two groups were compared.
CVS was applied to 41 patients. When the groups were compared in terms of operation time, postoperative length of stay, idiopathic gallbladder perforation, dropping stone, and presence of surgical site infection, no statistical significant difference was found. However, the time to start oral feeding was shorter in CVS group (p = 0.01).
We believe CVS is a reliable method to ensure safe cystic channel identification in the pediatric population. New studies are warranted on the effectiveness of CVS for safely performing laparoscopic cholecystectomy in children, as the procedure is being performed more frequently in the pediatric population.
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Reynolds W Jr (2001) The first laparoscopic cholecystectomy. JSLS 5:89–94
Sinacore J, Rosser JC Jr, Boeckman CR (1993) Pediatric laparoscopic cholecystectomy. A case study. AORN J 58:72–83. https://doi.org/10.1016/S0001-2092(07)65101-1
- Gallstones and laparoscopic cholecystectomy (1992) NIH consensus statement 10(3): 1–28
Walker SK, Maki AC, Cannon RM, Foley DS, Wilson KM, Galganski LA, Wiesenauer CA, Bond SJ (2013) Etiology and incidence of pediatric gallbladder disease. Surgery 154(4):927–931. https://doi.org/10.1016/j.surg.2013.04.040
Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125
Pucher PH, Brunt LM, Davies N, Linsk A, Munshi A, Rodriguez HA, Fingerhut A, Fanelli RD, Asbun H, Aggarwal R, Safe Cholecystectomy Task Force SAGES (2018) Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc 32:2175–2183. https://doi.org/10.1007/s00464-017-5974-2
Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Gomi H, Dervenis C, Windsor JA, Kim SW, de Santibanes E, Padbury R, Chen XP, Chan AC, Fan ST, Jagannath P, Mayumi T, Yoshida M, Miura F, Tsuyuguchi T, Itoi T, Supe AN, Committee TGR (2013) TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci 20:89–96. https://doi.org/10.1007/s00534-012-0567-x
Kelley-Quon LI, Dokey A, Jen HC, Shew SB (2014) Complications of pediatric cholecystectomy: impact from hospital experience and use of cholangiography. J Am Coll Surg. 218:73–81. https://doi.org/10.1016/j.jamcollsurg.2013.09.018
Raval MV, Lautz TB, Browne M (2011) Bile duct injuries during pediatric laparoscopic cholecystectomy: a national perspective. J Laparoendosc Adv Surg Tech A 21:113–118. https://doi.org/10.1089/lap.2010.0425
Strasberg SM (2019) A three-step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: an invited perspective review. J Hepatobiliary Pancreat Sci 26:123–127. https://doi.org/10.1002/jhbp.616
Babb J, Davis J, Tashiro J, Perez EA, Sola JE, Pandya S (2020) Laparoscopic versus open cholecystectomy in pediatric patients: a propensity score-matched analysis. J Laparoendosc Adv Surg Tech A 30:322–327. https://doi.org/10.1089/lap.2019.0655
Akhtar-Danesh GG, Doumouras AG, Bos C, Flageole H, Hong D (2018) Factors associated with outcomes and costs after pediatric laparoscopic cholecystectomy. JAMA Surg 153:551–557. https://doi.org/10.1001/jamasurg.2017.5461
Zeidan MM, Pandian TK, Ibrahim KA, Moir CR, Ishitani MB, Zarroug AE (2014) Laparoscopic cholecystectomy in the pediatric population: a single-center experience. Surg Laparosc Endosc Percutan Tech 24:248–250. https://doi.org/10.1097/SLE.0b013e3182a4c039
Rothstein DH, Harmon CM (2016) Gallbladder disease in children. Semin Pediatr Surg. 25:225–231. https://doi.org/10.1053/j.sempedsurg.2016.05.005
Strasberg SM, Eagon CJ, Drebin JA (2000) The “hidden cystic duct” syndrome and the infundibular technique of laparoscopic cholecystectomy–the danger of the false infundibulum. J Am Coll Surg 191:661–667. https://doi.org/10.1016/s1072-7515(00)00717-1
Wölnerhanssen BK, Ackermann C, Guenin MO, Kern B, Tondelli P, von Flüe M, Peterli R (2005) Zwölf Jahre laparoskopische Cholezystektomie Ergebnisse einer prospektiven Studie von 4498 an einer Klinik durchgeführten Cholezystektomien [Twelve years of laparoscopic cholecystectomy]. Chirurg 76:263–269. https://doi.org/10.1007/s00104-004-0928-3
Guzmán-Valdivia G (2008) Routine administration of antibiotics to patients suffering accidental gallbladder perforation during laparoscopic cholecystectomy is not necessary. Surg Laparosc Endosc Percutan Tech. 18:547–550. https://doi.org/10.1097/SLE.0b013e3181809e72
Altuntas YE, Oncel M, Haksal M, Kement M, Gundogdu E, Aksakal N, Gezen FC (2018) Gallbladder perforation during elective laparoscopic cholecystectomy: Incidence, risk factors, and outcomes. North Clin Istanb. 5:47–53. https://doi.org/10.14744/nci.2017.88155
Esposito C, Corcione F, Settimi A, Farina A, Centonze A, Esposito G, Spagnuolo MI, Escolino M (2019) 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 29:1185–1191. https://doi.org/10.1089/lap.2019.0254
Zamir G, Lyass S, Pertsemlidis D, Katz B (1999) The fate of the dropped gallstones during laparoscopic cholecystectomy. Surg Endosc 13:68–70. https://doi.org/10.1007/s004649900901
McPherson I, McSorley ST, Cannings E, Shearer CJ, Crumley AB (2019) Dropped gallstones causing abdominal wall abscess and pleural empyema: a case series. Scott Med J64:67–70. https://doi.org/10.1177/0036933018807653
Nugent L, Chandran P (2018) Need brooks no delay Peritoneo-cutaneous fistula formation secondary to gallstone dropped at laparoscopic cholecystectomy 20 years previously: a case report. J Surg Case Rep. https://doi.org/10.1093/jscr/rjy013
Garaud S, Stolz A (2018) Dropped gallstones mimicking peritoneal metastasis: A case report. Radiol Case Rep 13:878–881. https://doi.org/10.1016/j.radcr.2018.05.017
Brockmann JG, Kocher T, Senninger NJ, Schürmann GM (2002) Complications due to gallstones lost during laparoscopic cholecystectomy. Surg Endosc 16:1226–1232. https://doi.org/10.1007/s00464-001-9173-8
Esposito C, Gonzalez Sabin MA, Corcione F, Sacco R, Esposito G, Settimi A (2001) Results and complications of laparoscopic cholecystectomy in childhood. Surg Endosc 15:890–892. https://doi.org/10.1007/s004640000042
Chen K, Cheung K, Sosa JA (2012) Surgeon volume trumps specialty: outcomes from 3596 pediatric cholecystectomies. J Pediatr Surg 47:673–680. https://doi.org/10.1016/j.jpedsurg.2011.10.054
St Peter SD, Keckler SJ, Nair A, Andrews WS, Sharp RJ, Snyder CL, Ostlie DJ, Holcomb GW (2008) Laparoscopic cholecystectomy in the pediatric population. J Laparoendosc Adv Surg Tech A. 18:127–130. https://doi.org/10.1089/lap.2007.0150
Vettoretto N, Saronni C, Harbi A, Balestra L, Taglietti L, Giovanetti M (2011) Critical view of safety during laparoscopic cholecystectomy. JSLS 15:322–325. https://doi.org/10.4293/108680811X13071180407474
Strasberg SM, Brunt LM (2017) The Critical View of Safety: Why It Is Not the Only Method of Ductal Identification Within the Standard of Care in Laparoscopic Cholecystectomy. Ann Surg 265:464–465. https://doi.org/10.1097/SLA.0000000000002054
All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors have no conflicts of interest to declare. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
The necessary permission to conduct the research was obtained from the Non-Invasive Research Ethics Committee (86, 8/3/2019, No:32).
Informed consent was obtained from the patients’ parents.
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Kılıç, Ş.S., Özden, Ö. & Çolak, S.T. Comparative analysis of reliability and clinical effects of the critical view of safety approach used in laparoscopic cholecystectomy in the pediatric population. Pediatr Surg Int (2021). https://doi.org/10.1007/s00383-021-04869-3
- Laparoscopic cholecystectomy
- Common bile duct injury