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Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Efficacy of laparoscopic cholecystectomy in the pediatric population
Sabina Siddiqui1, Scott Newbrough, Daniel Alterman
1Department of Surgery, University of Tennessee-Knoxville, Knoxville, TN, USA.
Insights
Laparoscopic cholecystectomy effectively treats pediatric biliary dyskinesia, with 92.6% of children experiencing symptom resolution or improvement. This safe and durable procedure offers significant relief for children with biliary colic.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hepatobiliary Disease
Background:
- Gallbladder disease incidence is rising in children.
- Advancements in hepatobiliary scintigraphy and laparoscopic cholecystectomy have improved diagnosis and treatment.
- Biliary dyskinesia presents as biliary colic without gallstones.
Purpose of the Study:
- To evaluate the efficacy of laparoscopic cholecystectomy for pediatric biliary dyskinesia.
- To assess the predictive value of cholescintigraphy for surgical outcomes.
- To determine if laparoscopic cholecystectomy is a suitable treatment for children with biliary colic.
Main Methods:
- Retrospective review of 184 pediatric patients undergoing laparoscopic cholecystectomy.
- Correlation of postoperative outcomes with degree of dyskinesia, histopathology, gastrointestinal diagnoses, age, and sex.
- Biliary dyskinesia defined by ultrasonography and clinical biliary colic, excluding cholelithiasis.
Main Results:
- 100 out of 108 patients (92.6%) reported symptom resolution or improvement after surgery.
- Mean follow-up was 8.3 months; mean patient age was 14.1 years.
- No significant correlation found between outcomes and degree of dyskinesia, histopathology, age, or sex. Gastroesophageal reflux showed a non-significant trend towards better outcomes.
Conclusions:
- Laparoscopic cholecystectomy is a safe and effective treatment for pediatric biliary dyskinesia.
- The procedure demonstrates durable efficacy in relieving symptoms of biliary colic in children.
- Cholescintigraphy aids in diagnosis, but outcomes are not strongly predicted by ejection fraction alone.
Purpose:
Gallbladder disease is increasingly affecting the pediatric population. The advent of new technology in the 1980s, specifically, hepatobiliary scintigraphy and laparoscopic cholecystectomy, gave a dramatic rise in both the diagnosis and treatment of biliary disease in the pediatric population. The purpose of this study was to determine (a) whether laparoscopic cholecystectomy for biliary dyskinesia is efficacious in the treatment of children with biliary colic and (b) the ability of cholescintigraphy to predict which patients may benefit from an operative intervention.
Methods:
We performed a retrospective review of the records of all patients (N = 184) who underwent laparoscopic cholecystectomy, correlating postoperative results with degree of dyskinesia (percentage of ejection fraction), histopathology, associated gastrointestinal diagnoses, age, and sex. Biliary dyskinesia was defined by ultrasonography without evidence of cholelithiasis with clinical diagnosis of biliary colic.
Results:
Of the 184 patients who underwent laparoscopic cholecystectomy, 117 had a diagnosis of biliary dyskinesia and 108 were available for follow-up. Mean follow-up was 8.3 months. One hundred patients (92.6%) reported resolution or improvement of preoperative symptoms (64.8% reported complete resolution and 27.8% reported improvement in symptoms). The mean age of the patients was 14.1 years. No correlation was seen for degree of dyskinesia, histopathology, age, and sex. Patients with a preoperative diagnosis of gastroesophageal reflux were more likely to report resolution of symptoms, although this finding was not statistically significant. There was no major complication; 1 patient suffered a prolonged ileus, 1 patient suffered a wound infection, and 1 patient required incisional hernia repair.
Conclusion:
Laparoscopic cholecystectomy is safe, efficacious, and durable in children suffering from biliary dyskinesia.