Postoperative complications of laparoscopic cholecystectomy in children: two cases report

Abstract

Only a few studies have investigated the complications of laparoscopic cholecystectomy in children. Therefore, relevant case reports will be of interest to pediatric surgeons.

The patient was a 10-month-old boy diagnosed with calculous cholecystitis who underwent laparoscopic cholecystectomy. He had peripheral edema and adhesions in the neck of the gallbladder. After 10 h, a clinical picture of intra-abdominal bleeding developed. During relaparoscopy in the area of the gallbladder bed, arterial bleeding from the liver vessel was noted, which was eliminated by coagulation. The postoperative period was uneventful, and the child was discharged on day 8. In the second case, a 10-year-old girl was admitted for chronic calculous cholecystitis, and laparoscopic cholecystectomy was performed, in which a pronounced adhesion process was noted in the gallbladder neck region. On day 8, the child was discharged home; however, after 26 days, the patient was admitted again, with a clinical picture of diffuse biliary peritonitis. During laparoscopy, bile outflow from the gallbladder bed was noted, which only partially eliminated by monopolar electrocoagulation. Drainages were installed, through which bile began to be abundantly secreted in the postoperative period. Laparoscopy with a transition to open surgery was performed, during which a perforation in the wall of the common bile duct was found, and stenting and suturing of the defect were performed. In the postoperative period, active infusional infusion and antibacterial therapy were given. The patient was discharged on day 29.

Postoperative complications of the Clavien–Dindo type IIIb are associated both with the presence of congenital anatomical features and inflammatory-adhesive changes in the Calo triangle zone and with the possibility of latent lesions during monopolar coagulation in both cases. The evaluation of the tactics of eliminating biliary peritonitis in the second patient emphasized the necessity to switch to open laparotomy during the second operation.

These cases indicate the need to comply with the principles of safe laparoscopic cholecystectomy, including the availability of modern endoscopic equipment and the experience of surgeons in endosurgery. This requires the concentration of patients with cholelithiasis in specialized clinics.

Keywords

choledocholithiasis / laparoscopic cholecystectomy / postoperative complications / biliary peritonitis / hemoperitoneum / children

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