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Laparoscopic cholecystectomy for biliary dyskinesia in children: report of 100 cases from a single institution
Constantinos Constantinou1, Iswanto Sucandy, Max Ramenofsky
1Geisinger Medical Center, Danville, Pennsylvania 17822, USA. konteacy@aol.com
Insights
Laparoscopic cholecystectomy (LC) effectively treats biliary dyskinesia (BD) in children, with 77% experiencing symptom resolution. Low ejection fraction on HIDA scans reliably predicts successful outcomes for pediatric BD patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hepatobiliary System
Background:
- Laparoscopic cholecystectomy (LC) is increasingly utilized in pediatric patients.
- Biliary dyskinesia (BD) is the primary indication for LC in children.
- Diagnosis of BD involves biliary symptoms, absence of gallstones, and low ejection fraction (<35%) on HIDA scans.
Purpose of the Study:
- To review the outcomes of LC in pediatric patients diagnosed with BD.
- To identify predictors of successful LC outcomes in children with BD.
- To assess the long-term efficacy of LC for pediatric BD.
Main Methods:
- Retrospective review of prospectively collected data from 100 pediatric patients with BD undergoing LC.
- Analysis of electronic medical records including symptom duration and pre-operative HIDA scan ejection fraction.
- Comparison of outcomes between patients with symptom resolution and persistent symptoms post-LC.
Main Results:
- 77% of pediatric patients reported symptom resolution following LC for BD.
- Persistent symptoms were more common in female patients and those with longer pre-operative symptom duration.
- A HIDA scan ejection fraction <35% reliably predicted successful LC outcomes.
Conclusions:
- LC is an effective treatment for pediatric biliary dyskinesia.
- Early diagnosis and surgical referral for confirmed BD are recommended.
- Low ejection fraction on HIDA scans is a key indicator for successful LC in pediatric BD.
Abstract:
Laparoscopic cholecystectomy (LC) is increasingly performed in the pediatric population. Biliary dyskinesia (BD) is largely responsible for this increase and is presently the most common indication for LC in this age group. In our institution the diagnosis of BD is made in patients with biliary symptoms, absence of biliary stones, and an ejection fraction < 35 per cent on hydroxy iminoadiacetic acid (HIDA) scan. We reviewed our experience of 100 children with BD that underwent LC. Data that was prospectively collected and entered into electronic medical records by gastroenterologists, primary care physicians, and pediatric surgeons was reviewed and analyzed. Patients were symptomatic for an average of 15 months before undergoing surgery. Seventy-seven per cent reported resolution of symptoms from 6 months to 5 years following LC, whereas the rest complained of persistent symptomatology. When the two groups were compared, patients with persistent symptoms were more likely to be female and to have longer symptom duration. An ejection fraction < 35 per cent reliably predicts successful outcome of LC in patients with BD. The diagnosis of BD should be entertained early in the differential of functional abdominal pain in children and referred to Pediatric Surgery when its presence is confirmed.
