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A comparison of cholecystectomy and observation in children with biliary dyskinesia
Richard Scott Nelson1, Robert Kolts, Roger Park
1Department of General Surgery, Marshfield Clinic, Marshfield, WI 54449, USA. nelson.richard@marshfieldclinic.org <nelson.richard@marshfieldclinic.org>
Insights
In pediatric patients with biliary dyskinesia, cholecystectomy did not significantly improve long-term outcomes compared to no surgery. However, surgery offered quicker symptom relief, with weight loss being a key predictor of success.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes Research
Background:
- Biliary dyskinesia affects pediatric patients, with surgery often considered for symptom relief.
- Previous reports suggest an 80% success rate for ameliorating preoperative symptoms with intervention.
Purpose of the Study:
- To identify patient characteristics predicting successful outcomes in pediatric biliary dyskinesia.
- To compare outcomes between pediatric patients who underwent cholecystectomy versus a control group receiving no surgical intervention.
Main Methods:
- Retrospective review of medical charts for pediatric patients with biliary dyskinesia and abnormal ejection fraction (<35%).
- Data collected included psychological diagnoses, diagnostic findings, and outcomes at 1 month and 2 years postoperatively.
- Patients were divided into surgical (n=35) and control (n=20) groups.
Main Results:
- Both cholecystectomy (74% improvement) and non-surgical management (75% improvement) showed similar outcomes after 2 years.
- Weight loss was the only statistically significant patient characteristic identified for predicting outcomes.
- Patients undergoing cholecystectomy experienced faster abdominal pain resolution.
Conclusions:
- Long-term outcomes for pediatric biliary dyskinesia are similar with or without cholecystectomy.
- Cholecystectomy provides more rapid symptom relief for abdominal pain.
- Weight loss is a significant predictor of positive outcomes, but other patient characteristics were not statistically significant.
Purpose:
The success rate of ameliorating the preoperative symptoms of biliary dyskinesia in a pediatric population has been reported to be approximately 80%. The purpose of this study was to identify patient characteristics that may help to predict successful clinical outcomes in pediatric patients with biliary dyskinesia by comparing 2 groups of pediatric patients: those who underwent cholecystectomy and those who received no surgical intervention (control group).
Methods:
The medical charts of pediatric patients who had an ejection fraction of less than 35% and no other identifiable abnormalities revealed on diagnostic testing were retrospectively reviewed. Information regarding psychological diagnoses/treatment, diagnostic examination findings, histologic findings, and outcomes were collected. Patients were evaluated at 1 month and 2 years postoperatively.
Results:
From 1995 through 2003, 55 pediatric patients were identified. All patients had an abnormal ejection fraction on hepatobiliary iminodiacetic acid scan. The patients were divided into 2 groups: those who underwent cholecystectomy (n = 35) and a control group who did not receive surgical intervention (n = 20). Of those who underwent cholecystectomy, 74% improved, whereas 75% of the control group showed improvement after 2 years. Of all patient characteristics evaluated, only weight loss was found to be significant for determining patient outcomes.
Conclusion:
When followed for a long enough period of time, outcomes were similar between the 2 groups. Of the patients whose symptoms improved, those who underwent cholecystectomy had a quicker resolution of abdominal pain than those who did not undergo surgery. With the exception of weight loss, none of the patient characteristics evaluated in this study proved to be statistically significant for predicting a positive outcome.
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