Cholecystectomy using single-incision pediatric endosurgery: technique and initial experience in the first 25 cases.
BACKGROUND
Laparoscopic cholecystectomy has become the standard, in most pediatric surgery centers. In the search for a less-invasive procedure, a single-incision laparoscopic approach has been reported in adults and very few children.


OBJECTIVE
The aim of this study was to present our initial experience of cholecystectomy, using single-incision pediatric endosurgery (SIPES), including the technique, the intraoperative challenges, and the outcome.


METHODS
All pediatric patients who underwent a SIPES cholecystectomy from March through September 2009 were prospectively evaluated.


RESULTS
Twenty-five children underwent a SIPES cholecystectomy. The most frequent indications were symptomatic cholelithiasis in 17 patients (68%) and biliary dyskinesia in 5 (20%). Five patients had sickle-cell anemia. The mean operative time was 73 minutes (range, 30-122). Median hospital stay was 1 day. In 17 patients (68%), a percutaneous 2-mm grasper was used to retract the gallbladder over the liver. No complications were noted, and no conversion to an open procedure was required. In 5 patients, additional trocars were added. On follow-up, 3 days to 2 months later, no complications were noted. No patients were readmitted, and there were no wound infections.


CONCLUSIONS
Cholecystectomy, when using the SIPES approach in children, is a safe, reasonable alternative to conventional laparoscopy, leaving an inconspicuous scar. Whether SIPES offers any further benefit to the patient, besides improved cosmesis, should be evaluated in future studies.
Nougues
Cecilia Puga
CP
Division of Pediatric Surgery, Children's Hospital of Alabama, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
Harmon
Carroll M
CM
Hansen
Erik N
EN
Georgeson
Keith E
KE
Muensterer
Oliver J
OJ
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications; D001657:Biliary Dyskinesia / Q000601:surgery; D001660:Biliary Tract Diseases / Q000209:etiology / Q000601:surgery*; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome