Vol.:(0123456789) 1 3 Journal of Pediatric Endoscopic Surgery https://doi.org/10.1007/s42804-020-00063-9 ORIGINAL RESEARCH Laparoscopic cholecystectomy by paediatric surgeons: can established standards of care be delivered? Jonathan Ducey 1  · David J. Wilkinson 1  · Robert T. Peters 1  · Ross J. Craigie 1  · Paul J. Farrelly 1  · Nick Lansdale 1 Received: 12 April 2020 / Revised: 26 May 2020 / Accepted: 9 June 2020 © Springer Nature Singapore Pte Ltd 2020 Abstract Purpose Laparoscopic cholecystectomy (LC) case volume is low for paediatric surgeons relative to the adult sector; coupled with service diferences, internationally accepted standards may be more challenging to meet. This study sought to determine (i) the outcomes of LC in children, and (ii) whether recognised care pathways (e.g. acute LC, access to cholangiogram/ERCP and day-case LC provision) can be delivered. Methods Patients who underwent LC were identifed retrospectively in a single institution between January 2009 and Janu- ary 2019. Data are presented as median [IQR] and continuous variables compared using a t test. Results 101 cases were included (age 12.9 years [10.2–15]; female 65/101). Indications for LC were symptomatic gallstones (98/101) and polyps (2/101). ERCP and/or endoscopic ultrasound were performed in 23/101. For acute presentations, 7/24 (29%) had LC during the same admission. Trainees performed LC in 33/101. 4/101 required intra-operative cholangiogram. Operative time was 109.5 min [90.8–139.5]: consultant vs. trainee times were similar (114 [93.3–149.5] vs. 99.5 [81.5–125.3], p = 0.06). Length of stay was one day [1–1] with 10/101 being day-cases. There were no major complications or re-operations. Conclusion We report good outcomes from LC. Furthermore, we have demonstrated the capacity to deliver recognised standards of care within a paediatric setting. Keywords Cholecystectomy · Quality standards · Child · Laparoscopic Introduction Following early reports of laparoscopic cholecystectomy (LC) in the paediatric population, over recent years there has been a signifcant increase in paediatric cholecystectomies alongside a rising incidence of childhood biliary lithiasis [1–4]. Whilst often associated with benign haematological disease, a shift in aetiopathology has also led to a rise in the signifcant complications associated with biliary lithiasis in children [4–9]. This shift in prevalence is of no surprise given the concurrent increasing prevalence of childhood obesity and thus an increase in cholesterol-based stone for- mation [10]. Indeed, some large recent series’ have demon- strated haemolytic disease to no longer be the predominant risk factor for symptomatic gallstone disease in children [8]. As such, historic diferences in the clinical and surgi- cal management between paediatric and adult surgeons are becoming less distinct. It is well recognised that the treatment for symptomatic cholelithiasis is the surgical removal of the gallbladder. In the absence of absolute contraindications, LC is widely accepted as the gold standard technique across both adult and paediatric populations. Plentiful data from the adult sec- tor have formed an extensive evidence base for national com- missioning tools and the National Institute of Clinical Excel- lence (NICE) guidance within the United Kingdom (UK) [11, 12]. Comparable documents are found internationally [13]. Recommendations focus on clinical assessment, diag- nostics, management, and service standards for adult patients with gallstone disease from primary through to tertiary level care. Paediatric data remain comparably limited: adult guid- ance is often extrapolated to the paediatric population [4, 7]. We sought to review our experience and outcomes of paediatric LC and assess whether internationally accepted standards of care quality from the adult sector are achievable in the paediatric setting. These include (1) access to early * Nick Lansdale nick.lansdale2@mft.nhs.uk 1 Department of Paediatric and Neonatal Surgery, Royal Manchester Children’s Hospital, Oxford Road, Manchester M13 9WL, UK