title: Two-Incision Laparoscopic Cholecystectomy in Children.
abstract: OBJECTIVE
  To evaluate two-incision laparoscopic cholecystectomy (2I-LC) in children, and compare outcomes with four-port laparoscopic cholecystectomy (4P-LC).
  
  
  METHODS
  A retrospective review was performed on children (≤21 years) with gallbladder disease treated with 2I-LC or 4P-LC between February 2010 and February 2016. 2I-LC is performed using two 5-mm ports and a 2-mm endoscopic grasper within a 12-mm umbilical incision, and a 3-mm subxiphoid port for dissection. Demographic, diagnostic, operative, and outcome data were recorded, and the two groups were compared with chi-squared, Fisher, and t-tests. Patients requiring conversion from 2I-LC to 4P-LC were examined to determine factors predicting the need for additional ports.
  
  
  RESULTS
  Three hundred eighty-nine laparoscopic cholecystectomies were performed (2I-LC 72.0%, 4P-LC 19.0%). Body mass index (BMI) was greater in the 4P-LC group. 2I-LC was more commonly performed for biliary dyskinesia, but not biliary colic, acute cholecystitis, choledocholithiasis, and gallstone pancreatitis. Operative time was greater in 4P-LC. There were 6 wound infections (2I-LC 1.8%, 4P-LC 1.5%), 1 common bile duct injury (2I-LC 0.4%, 4P-LC 0.0%), and 1 small bowel injury (2I-LC 0.0%, 4P-LC 1.5%). 2.4% of 2I-LC required conversion to 4P-LC, with BMI and operative time greater than the 2I-LC group, but not different from 4P-LC with no complications.
  
  
  CONCLUSIONS
  2I-LC is a safe alternative to 4P-LC for pediatric gallbladder disease, allowing for traction and countertraction to expose the critical view. Operative time was longer in the 4P-LC group, likely secondary to selection bias with higher BMI and preoperative diagnosis of gallstone disease. Overweight patients are more likely to require additional ports.
authors.affiliation: 1 Alberta Children's Hospital , Calgary, Alberta, Canada .|2 Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Lai
authors.affiliation: 2 Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Rothenberg
authors.affiliation: 2 Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Kristin E
authors.initials: KE
authors.lastname: Shipman
authors.affiliation: 2 Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Saundra M
authors.initials: SM
authors.lastname: Kay
authors.affiliation: 2 Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Slater
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: cholecystectomy; laparoscopy; pediatric; two-incision