Bacteriology of cholelithiasis in infants and children

Today, laparoscopic cholecystectomy is rapidly replacing traditional cholecystectomy as the standard treatment of symptomatic cholelithiasis in children. We reviewed the bile cultures and postoperative course of 30 children who underwent laparoscopic cholecystectomy with the aim of establishing a routine policy for perioperative antibiotic treatment and for the management of biliary leak during that procedure. A positive bile culture was found in only one child (Salmonella Group D). All patients, including six children with intraoperative bile spillage, had a completely normal and uneventful postoperative course. We concluded that the use of preoperative antibiotic treatment should be limited in laparoscopic cholecystectomy in children and is probably not required at all, awaiting proof from a further study. The present study further showed that intraoperative bile spillage is of no clinical significance and can be treated simply with local saline irrigation during the laparoscopic procedure.