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Changing indications for pediatric cholecystectomy
D M Miltenburg1, R Schaffer, T Breslin
1Michael E. DeBakey, Baylor College of Medicine, Houston, Texas 77030, USA.
Insights
Gallbladder surgery in children is recommended for those with medical conditions. Urgent surgery carries higher risks, especially for those with congenital heart disease, where elective procedures may be safer.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Public Health
Background:
- Gallbladder disease and the need for cholecystectomy (gallbladder removal) can occur in children.
- Identifying risk factors for urgent gallbladder surgery is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the indications for gallbladder surgery in pediatric patients.
- To identify risk factors associated with urgent cholecystectomy in children.
Main Methods:
- A retrospective review of all patients under 19 years old who underwent cholecystectomy between 1980 and 1996.
- Analysis of patient demographics, medical history, surgical urgency, and postoperative outcomes.
Main Results:
- 128 pediatric patients underwent cholecystectomy; 25% required urgent surgery.
- Urgent surgery was associated with higher postoperative complication rates (16% vs. 6%) and mortality (odds ratio: 23).
- Congenital heart disease was an independent, significant risk factor for gallstone-related mortality (odds ratio: 183).
Conclusions:
- Cholecystectomy is advised for children with underlying medical conditions requiring gallbladder removal.
- Children with significant medical disorders face higher morbidity with urgent surgery; clinical monitoring may be an alternative.
- Elective cholecystectomy may be a safer option for pediatric patients with congenital heart disease and gallstones due to the high mortality risk associated with urgent procedures.
Purpose:
The purpose of this study was to determine indications for gallbladder surgery and risk factors for urgent surgery.
Methods:
We reviewed all patients <19 years old, who underwent cholecystectomy between 1980 and 1996.
Results:
There were 128 patients (mean age: 10 years). Fifty-two patients had an underlying hematologic disorder, 47 had another medical disorder, and 29 had no preexisting illness or identifiable risk factor for gallstone disease. Twenty-five percent (32/128) of cholecystectomies were performed urgently. Postoperative complications developed in 5 of 32 patients (16%) who underwent emergency surgery and 6 of 96 patients (6%) who underwent elective surgery. There were 3 deaths, all occurring in patients undergoing emergency cholecystectomy (odds ratio: 23). Furthermore, all who died had congenital heart disease (odds ratio: 183), making congenital heart disease an independent risk factor for gallstone-related mortality.
Conclusions:
Cholecystectomy is recommended when medically possible for children with underlying medical diseases. Patients with medical disorders that make them a high surgical risk can be followed clinically, realizing that if urgent surgery is necessary, the morbidity is relatively high. Those children with congenital heart disease and gallstones are at a prohibitively high risk for death after urgent cholecystectomy. For these patients, the risk of an elective cholecystectomy may be acceptable when weighed against the high risk of complications from their gallstones.