Who should perform pediatric laparoscopic cholecystectomies? A systematic review of the literature
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In brief
In brief
Systematic review comparing outcomes of pediatric laparoscopic cholecystectomy performed by high-volume adult surgeons versus pediatric surgeons across 19,993 patients. High-volume adult surgeons demonstrated lower complication rates, shorter hospital stays, and reduced costs for simple cholelithiasis cases, while complex patients benefited from pediatric surgeon expertise and multidisciplinary care.
- High-volume adult surgeons show lower complication rates and shorter hospital stays for pediatric laparoscopic cholecystectomy.
- For simple cholelithiasis in children, high-volume adult surgeons demonstrate statistically significant reductions in complications and readmissions.
- Pediatric surgeons are recommended for complex cases requiring multidisciplinary pediatric specialist input beyond the surgical procedure.
- Overall morbidity for pediatric LC is comparable to adult populations when performed by experienced surgeons.
- Surgeon volume appears more predictive of outcomes than specialty training for straightforward pediatric gallbladder disease.
Written by the GCMD Library team from the article.
Abstract
Laparoscopic cholecystectomy (LC) is an increasingly common operation in the pediatric population, although numbers remain significantly lower than in adults. Currently, this operation is performed by both adult and pediatric surgeons and there is no consensus as to whether specialist low-volume or adult high-volume surgeons should be performing this operation. A literature search was performed to compare the outcomes following pediatric LC when performed by adult or pediatric surgeons. 19,993 patients were included in this analysis. Overall, post-operative complications were reduced when LC was performed by high-volume adult surgeons, along with reduced length of stay and associated cost. Overall morbidity following LC in children is comparable to adults. When performed by higher volume adult surgeons, there was a statically significant reduction in post-operative complications and re-admission rates. Morbidity was also reduced in patients with simple cholelithiasis. Initial results show that in pediatric patients presenting with cholelithiasis, LC performed by a high-volume adult general surgeon is safer. In more complex children with needs from other specialist pediatricians, surgery performed by a pediatric surgeon is recommended. Further research with direct comparisons is still required.