{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T09:26:58Z","timestamp":1790414818172,"version":"4.1.0"},"reference-count":37,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T00:00:00Z","timestamp":1698710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: In children, laparoscopic cholecystectomy (LC) is now considered the gold standard for gallbladder (GB) removal. In the past, hemolytic disorders associated with cholelithiasis represented the most frequent conditions requiring LC; this is being overtaken by cholelithiasis and biliary conditions in overweight or ex-premature children. Aims: This study aims to describe current indications and timing for LC in pediatric patients. Methods: Retrospective study. Data on previous medical therapy, ultrasound, pre- and intraoperative aspects, and histology were collected for patients treated in 2020\u20132023. Results: In total, 45 patients were enrolled: 15 who underwent urgent surgery and 30 electives. Groups differed in terms of obesity rate, symptoms, ultrasound features, and intraoperative status. The most relevant risk factors for surgical complexity were age and pubertal stage, elevated cholestasis indexes, and gallbladder wall thickness &gt; 3 mm at ultrasound. GB wall thickening \u22653 mm, US Murphy sign, fluid collections, and gallbladder distention on ultrasound correlated with high surgical scores. Conclusions: Indications for laparoscopic cholecystectomy in children seem to evolve caused by changing characteristics of the pediatric population. Patients with overweight\/obesity may develop more complex GB diseases. Asymptomatic patients should be considered for surgery after observation, considering age and\/or pubertal maturation when other risk factors are absent.<\/jats:p>","DOI":"10.3390\/children10111771","type":"journal-article","created":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T12:44:03Z","timestamp":1698756243000},"page":"1771","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Laparoscopic Cholecystectomy in Children: The Experience of Two Centers Focusing on Indications and Timing in the Era of \u201cNew Technologies\u201d"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0206-2892","authenticated-orcid":false,"given":"Francesca","family":"Destro","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo Maria","family":"Pierucci","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Durante","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Maria","family":"Caruso","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Unit, Children\u2019s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenza","family":"Girgenti","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Unit, Children\u2019s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta Paola Maria","family":"Canonica","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8123-7522","authenticated-orcid":false,"given":"Irene","family":"Degrassi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Buzzi Children\u2019s Hospital, University of Milan, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Campari","sequence":"additional","affiliation":[{"name":"Department of Pediatric Radiology, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Pellegrinelli","sequence":"additional","affiliation":[{"name":"Pathology Unit, Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli Sacco, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Barisella","sequence":"additional","affiliation":[{"name":"Pathology Unit, Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli Sacco, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Nebuloni","sequence":"additional","affiliation":[{"name":"Pathology Unit, Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli Sacco, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Brunero","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1202-5873","authenticated-orcid":false,"given":"Elia Mario","family":"Biganzoli","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Sciences (DIBIC) & Data Science Research Center (DSRC), Unit of Clinical Research and Medical Statistics, Ospedale \u201cL. Sacco\u201d LITA Campus, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Calcaterra","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Buzzi Children\u2019s Hospital, University of Milan, 20154 Milan, Italy"},{"name":"Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Pelizzo","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"},{"name":"Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e133","DOI":"10.1016\/j.surge.2022.09.003","article-title":"Laparoscopic cholecystectomy in children: A systematic review and meta-analysis","volume":"21","author":"Mattson","year":"2022","journal-title":"Surgeon"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"St Peter, S.D., Keckler, S.J., Nair, A., Andrews, W.S., Sharp, R.J., Snyder, C.L., Ostlie, D.J., and Holcomb, G.W. (2008). Laparoscopic cholecystectomy in the pediatric population. J. Laparoendosc. Adv. Surg. Tech. A, 18.","DOI":"10.1089\/lap.2007.0150"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Miltenburg, D.M., Schaffer, R., Breslin, T., and Brandt, M.L. (2000). Changing indications for pediatric cholecystectomy. Pediatrics, 105.","DOI":"10.1542\/peds.105.6.1250"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Curr\u00f2, G., Lapichino, G., Lorenzini, C., Palmeri, R., and Cucinotta, E. (2006). Laparoscopic cholecystectomy in children with chronic hemolytic anemia. Is the outcome related to the timing of the procedure?. Surg. Endosc., 20.","DOI":"10.1007\/s00464-005-0318-z"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"122","DOI":"10.3389\/fped.2020.00122","article-title":"Biliary Dyskinesia in Children and Adolescents: A Mini Review","volume":"8","author":"Simon","year":"2020","journal-title":"Front. Pediatr."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Koebnick, C., Smith, N., Black, M.H., Porter, A.H., Richie, B.A., Hudson, S., Gililland, D., Jacobsen, S.J., and Longstreth, G.F. (2012). Pediatric obesity and gallstone disease. J. Pediatr. Gastroenterol. Nutr., 55.","DOI":"10.1097\/MPG.0b013e31824d256f"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3389\/fped.2020.00203","article-title":"Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing","volume":"8","author":"Pelizzo","year":"2020","journal-title":"Front. Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/s13312-019-1535-1","article-title":"Gallbladder Disease in Children: A 20-year Single-center Experience","volume":"56","author":"Aralica","year":"2019","journal-title":"Indian Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1007\/s13304-021-01227-9","article-title":"Cholelithiasis management in a third-level pediatric center: Case series and literature review","volume":"74","author":"Wong","year":"2022","journal-title":"Updates Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1097\/XCS.0000000000000650","article-title":"Pediatric DUCT Score: A Highly Specific Predictive Model for Choledocholithiasis in Children","volume":"236","author":"Ignacio","year":"2023","journal-title":"J. Am. Coll. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jhbp.516","article-title":"Tokyo guidelines 2018: Flowchart for the management of acute cholecystitis","volume":"25","author":"Okamoto","year":"2018","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Calcaterra, V., Palombo, C., Malacarne, M., Pagani, M., Federico, G., Kozakova, M., Zuccotti, G., and Lucini, D. (2021). Interaction between Autonomic Regulation, Adiposity Indexes and Metabolic Profile in Children and Adolescents with Overweight and Obesity. Children, 8.","DOI":"10.3390\/children8080686"},{"key":"ref_13","unstructured":"Harvard, T.H. (2021, April 02). Chan School of Public Health. Defining Childhood Obesity. Available online: https:\/\/www.hsph.harvard.edu\/obesity-prevention-source\/obesity-definition\/defining-childhood-obesity\/#References."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1136\/adc.45.239.13","article-title":"Variations in the pattern of pubertal changes in boys","volume":"45","author":"Marshall","year":"1970","journal-title":"Arch. Dis. Child."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Destro, F., Salerno, R., Calcaterra, V., Ardizzone, S., Meroni, M., Roveri, M., Pierucci, U., Zaja, A., Rizzetto, F., and Campari, A. (2023). Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children. Children, 10.","DOI":"10.3390\/children10040760"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.mri.2012.05.001","article-title":"3D Slicer as an image computing platform for the Quantitative Imaging Network","volume":"30","author":"Fedorov","year":"2012","journal-title":"Magn. Reson. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.jpedsurg.2013.11.053","article-title":"Cholecystectomy in English children: Evidence of an epidemic (1997\u20132012)","volume":"49","author":"Khoo","year":"2014","journal-title":"J. Pediatr. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Siddiqui, S., Newbrough, S., Alterman, D., Anderson, A., and Kennedy, A. (2008). Efficacy of laparoscopic cholecystectomy in the pediatric population. J. Pediatr. Surg., 43.","DOI":"10.1016\/j.jpedsurg.2007.09.031"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Vegunta, R.K., Raso, M., Pollock, J., Misra, S., Wallace, L.J., Torres, A., and Pearl, R.H. (2005). Biliary dyskinesia: The most common indication for cholecystectomy in children. Surgery, 138.","DOI":"10.1016\/j.surg.2005.06.052"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Walker, T.M., Hambleton, I.R., and Serjeant, G.R. (2000). Gallstones in sickle cell disease: Observations from the Jamaican Cohort study. J. Pediatr., 136.","DOI":"10.1016\/S0022-3476(00)90054-4"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S0002-9610(05)80930-4","article-title":"Natural history of asymptomatic and symptomatic gallstones","volume":"165","author":"Friedman","year":"1993","journal-title":"Am. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1542\/pir.2019-0077","article-title":"Gallbladder, gallstones, and diseases of the gallbladder in children","volume":"41","author":"Goldman","year":"2020","journal-title":"Pediatr. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1111\/jpc.13235","article-title":"Risk factors, complications and outcome of cholelithiasis in children: A retrospective, single-centre review","volume":"52","author":"Bayram","year":"2016","journal-title":"Paediatr. Child Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/j.jpedsurg.2022.11.012","article-title":"Treatment of asymptomatic gallstones in children with hereditary spherocytosis requiring splenectomy","volume":"58","author":"Liu","year":"2023","journal-title":"J. Pediatr. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.cgh.2022.04.010","article-title":"The Natural History of Asymptomatic Gallstones: A Longitudinal Study and Prediction Model","volume":"21","author":"Sarvepalli","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1055\/a-0862-0346","article-title":"Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline","volume":"51","author":"Manes","year":"2019","journal-title":"Endoscopy"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"62","DOI":"10.4240\/wjgs.v11.i2.62","article-title":"Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy","volume":"11","author":"Gupta","year":"2019","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_28","first-page":"477","article-title":"Relevance of the critical view of safety as a standardized step in laparoscopic cholecystectomy","volume":"87","year":"2019","journal-title":"Cirug\u00eda Cir."},{"key":"ref_29","first-page":"23","article-title":"Validation of a scoring system to predict difficult laparoscopic cholecystectomy: A one-year cross-sectional study","volume":"8","author":"Veerank","year":"2018","journal-title":"J. West Afr. Coll. Surg."},{"key":"ref_30","first-page":"608","article-title":"A risk score to predict the difficulty of elective laparoscopic cholecystectomy","volume":"9","author":"Soltes","year":"2014","journal-title":"Wideochirurgia I Inne Tech. Maloinwazyjne"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1001\/archinte.1997.00440360088009","article-title":"Gallstone size and risk of pancreatitis","volume":"157","author":"Diehl","year":"1997","journal-title":"Arch. Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1007\/s00383-018-4300-y","article-title":"Is 14 the new 40: Trends in gallstone disease and cholecystectomy in Australian children","volume":"34","author":"Greer","year":"2018","journal-title":"Pediatr. Surg. Int."},{"key":"ref_33","first-page":"83","article-title":"Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary","volume":"49","author":"Tringali","year":"2017","journal-title":"Endoscopy"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Pogoreli\u0107, Z., Lovri\u0107, M., Juki\u0107, M., and Perko, Z. (2022). The Laparoscopic Cholecystectomy and Common Bile Duct Exploration: A Single-Step Treatment of Pediatric Cholelithiasis and Choledocholithiasis. Children, 9.","DOI":"10.3390\/children9101583"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/j.surg.2021.09.041","article-title":"Management of complicated biliary disease in the pediatric population","volume":"171","author":"Doud","year":"2022","journal-title":"Surgery"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3275","DOI":"10.1007\/s00464-018-06613-w","article-title":"Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: A meta-analysis","volume":"33","author":"Lyu","year":"2019","journal-title":"Surg. Endosc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"6366","DOI":"10.1007\/s00464-021-08596-7","article-title":"Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA\u2122 technology: Preliminary experience in two pediatric surgery centers","volume":"35","author":"Esposito","year":"2021","journal-title":"Surg. Endosc."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/11\/1771\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:15:07Z","timestamp":1760130907000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/11\/1771"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,31]]},"references-count":37,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["children10111771"],"URL":"https:\/\/doi.org\/10.3390\/children10111771","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,31]]}}}