Complications of cholelithiasis in children as indications for emergency surgery

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.