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Published Online: 5 March 2020

Laparoscopic Versus Open Cholecystectomy in Pediatric Patients: A Propensity Score-Matched Analysis

Publication: Journal of Laparoendoscopic & Advanced Surgical Techniques
Volume 30, Issue Number 3


Background: As minimally invasive pediatric surgery becomes standard approach to many surgical solutions, access has become an important point for improvement. Laparoscopic cholecystectomy (LC) is the gold standard for many conditions affecting the gallbladder; however, open cholecystectomy (OC) is offered as the initial approach in a surprisingly high percentage of cases.
Materials and Methods: The Kids' Inpatient Database (1997–2012) was searched for International Classification of Disease, 9th revision, Clinical Modification procedure code (51.2x). LC and OC performed in patients <20 years old were identified. Propensity score-matched analyses using 39 variables were performed to isolate the effects of race, income group, location, gender, payer status, and hospital size on the percentage of LCs and OCs offered. Cases were weighted to provide national estimates.
Results: A total of 78,578 cases were identified, comprising LC (88.1%) and OC (11.9%). Girls were 1.6 (CI: 1.4, 1.7) times more likely to undergo LC versus boys. Large facilities were 1.4 (1.3, 1.7) times more likely to perform LCs than small facilities. Children in lower income quartiles were 1.2 (1.1, 1.3) times more likely to undergo LC compared with those in higher income quartiles. Rates of LC were not affected by race, hospital location, or payer status.
Conclusions: Risk-adjusted analysis of a large population-based data set demonstrated evidence that confirms, but also refutes, traditional disparities to minimally invasive surgery access. Despite laparoscopic gold standard, OC remains the initial approach in a surprisingly high percentage of pediatric cases independent of demographics or socioeconomic status. Additional research is required to identify factors affecting the distribution of LC and OC within the pediatric population.

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1. Sattarova V, Eaton S, Hall NJ, Lapidus-Krol E, Zani A, Pierro A. Laparoscopy in pediatric surgery: Implementation in Canada and supporting evidence. J Pediatr Surg 2016;51:822–827.
2. Sakpal SV, Bindra SS, Chamberlain RS, Laparoscopic cholecystectomy conversion rates two decades later. JSLS 2010;14:476–483.
3. Sinacore J, Rosser JC, Boeckman CR. Pediatric laparoscopic cholecystectomy. A case study. AORN J 1993;58:72–83.
4. Newman KD, Marmon LM, Attorri R, Evans S. Laparoscopic cholecystectomy in pediatric patients. J Pediatr Surg 1991;26:1184–1185.
5. Sigman HH, Laberge JM, Croitoru D, Hong A, Sigman K, Nguyen LT, Guttman FM. Laparoscopic cholecystectomy: A treatment option for gallbladder disease in children. J Pediatr Surg 1991;26:1181–1183.
6. Holcomb GW, Olsen DO, Sharp KW. Laparoscopic cholecystectomy in the pediatric patient. J Pediatr Surg 1991;26:1186–1190.
7. Kim P, Wesson D, Superina R, Filler R. Laparoscopic cholecystectomy versus open cholecystectomy in children: Which is better? J Pediatr Surg 19;30:971–973.
8. Al-Salem AH, Qaisaruddin S, Al-Abkari H, Nourallah H, Yassin YM, Varma KK. Laparoscopic versus open cholecystectomy in children. Pediatr Surg Int 1997;12:587–590.
9. Holcomb GW, Sharp KW, Neblett WW, Morgan WM, Pietsch JB. Laparoscopic cholecystectomy in infants and children: Modifications and cost analysis. J Pediatr Surg 1994;29:900–904.
10. Davidoff AM. Branum GD, Murray EA, Chong WK, Ware RE, Kinney TR, Pappas TN, Meyers WC. The technique of laparoscopic cholecystectomy in children. Ann Surg 1992;215:186–191.
11. Esposito C, Gonzalez Sabin MD, Corcione F, Sacco R, Esposito G, Settimi A. Results and complications of laparoscopic cholecystectomy in childhood. Surg Endosc 2001;15:890–892.
12. Simi M, Schietroma M, Carlei F, Iannucci D, Cianca G, Leardi S. Is laparoscopic cholecystectomy a safe alternative to open cholecystectomy for pediatric patients with cholelithiasis? Endoscopy 1996;28:312–315.
13. Gigot J, Etienne J, Aerts R, Wibin E, Dallemagne B, Deweer F, Fortunati D, Legrand M, Vereecken L, Doumont J, Van Reepinghen P, Beguin C. The dramatic reality of biliary tract injury during laparoscopic cholecystectomy. An anonymous multicenter Belgian survey of 65 patients. Surg Endosc 1997;11:1171–1178.
14. Halbert C, Pagkratis S, Yang J, Meng Z, Altieri MS, Parikh P, Pryor A, Talamini M, Telem DA. Beyond the learning curve: Incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era. Surg Endosc 2016;30:2239–2243.
15. Kelley-Quon LI, Dokey A, Jen HC, Shew SB. Complications of pediatric cholecystectomy: Impact from hospital experience and use of cholangiography. J Am Coll Surg 2014;218:73–81.
16. Firilas AM, Jackson RJ, Smith SD. Minimally invasive surgery: The pediatric surgery experience. J Am Coll Surg 1998;186:542–544.
17. Vaerla JE, Nguyen NT. Disparities in access to basic laparoscopy surgery at U.S. academic medical center. Surg Endosc 2001;25:1209–1214.
18. Smith JF, Boysen D, Tschirhart J, Williams T. Risks and benefits of laparoscopic cholecystectomy in the community hospital setting. J Laparoendosc Surg 1991;1:325–332.
19. Kreuder KA, Chown M. Laparoscopic cholecystectomy in the rural setting. J Laparoendosc Surg 1992;2:89–92.
20. Martin M, Abrams M, Arkin R, Ballen P, Blievemicht S, Bowman W, Davis T, Farley R, Hoxworth B, Ingram H, et al. Safe laparoscopic cholecystectomy in a community setting, N = 762. Surg Endosc 1992;7:300–303.
21. Gahagan JV, Hanna M, Whealon M, Maximus S, Phan MJ, Lekawa M, Barrios C, Bernal NP. Racial disparities in access and outcomes of cholecystectomy in the United States. Amer Surg 2016;82:921–925.
22. Chan S, Currie J, Malik AI, Mahomed AA. Paediatric cholecystectomy: Shifting goalposts in the laparoscopic era. Surg Endosc 2008;22:1392–1395.
23. Miltenburg DM, Schaffer R, Breslin T, Brandt ML. Changing indications for pediatric cholecystectomy. Pediatrics 2000;105:1250–1263.
24. Clements RH, Holcomb GW. Laparoscopic cholecystectomy. Curr Opin Pediatr 1998;10:310–314.
25. Siddiqui S, Newbrough S, Alterman D, Anderson A, Kennedy A. Efficacy of laparoscopic cholecystectomy in the pediatric population. J Pediatr Surg 2009;44:2063.
26. St Peter SD, Keckler SJ, Nair A, Andrews WS, Sharp RJ, Snyder CL, Ostlie DJ, Holcomb GW. Laparoscopic cholecystectomy in the pediatric population. J Laparoendosc Adv Surg Tech A 2008;18:127–130.

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Published In

cover image Journal of Laparoendoscopic & Advanced Surgical Techniques
Journal of Laparoendoscopic & Advanced Surgical Techniques
Volume 30Issue Number 3March 2020
Pages: 322 - 327
PubMed: 32045322


Published online: 5 March 2020
Published in print: March 2020
Published ahead of print: 11 February 2020


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Jaqueline Babb
Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.
James Davis
Department of Surgery, University of North Texas Health Science Center, Dallas, Texas.
Jun Tashiro
Department of Surgery, Children's National Medical Center, Washington, District of Columbia.
Eduardo A. Perez
Department of Surgery, University of Miami, Miami, Florida.
Juan E. Sola
Department of Surgery, University of Miami, Miami, Florida.
Samir Pandya [email protected]
Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.


Address correspondence to: Samir Pandya, MD, Department of Surgery, UT Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX 75235 [email protected]

Disclosure Statement

Samir Pandya is a consultant for TransEnterix.

Funding Information

No funding was received for this article.

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