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Outcomes after laparoscopic cholecystectomy in children with biliary dyskinesia
Hernando Lyons1, Karen H Hagglund, Yamen Smadi
1St John Hospital and Medical Center, Detroit, MI, USA. hernando.lyons@stjohn.org
Insights
Biliary dyskinesia (BD) is an indication for cholecystectomy in 20% of pediatric patients. An ejection fraction (EF) of 11% or less is a key predictor of symptom resolution after surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Biliary System Disorders
Background:
- Biliary dyskinesia (BD) is a functional gallbladder disorder causing abdominal pain.
- Cholecystectomy is a common surgical treatment for symptomatic BD in children.
- Identifying predictors of successful surgical outcomes is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of BD as an indication for cholecystectomy in pediatric patients.
- To identify clinical findings associated with symptom resolution post-cholecystectomy.
- To establish the optimal ejection fraction (EF) predictive of successful outcomes.
Main Methods:
- Retrospective review of medical records for 212 pediatric patients undergoing cholecystectomy (1998-2006).
- Assessment of short-term outcomes via record review and long-term outcomes via questionnaire.
- Statistical analysis using chi-square tests and logistic regression to evaluate predictors of symptom resolution.
Main Results:
- Biliary dyskinesia (BD) accounted for 20% of cholecystectomies in the study cohort.
- An ejection fraction (EF) of ≤11% significantly predicted higher rates of symptom resolution (P=0.02).
- Right upper quadrant pain showed a trend towards better long-term improvement but did not reach statistical significance (P=0.057).
Conclusions:
- Cholecystectomy is indicated for BD in a significant proportion of pediatric patients.
- An EF of ≤11% is a strong predictor of successful symptom resolution following cholecystectomy for BD.
- Further research may refine criteria for surgical intervention in pediatric BD.
Abstract:
Our objectives were to determine the prevalence of biliary dyskinesia (BD) as an indication for cholecystectomy in children and to identify presenting clinical findings and optimal ejection fraction (EF) associated with the resolution of symptoms after surgery. We conducted a retrospective review of medical records of 212 pediatric patients who underwent cholecystectomy from August, 1998 to November, 2006. Patients who met criteria for BD had their short-term outcomes examined by record review and their long-term postoperative outcomes recorded by questionnaire. To compare EF and clinical presentation to symptom resolution or outcome, χ tests were used. Logistic regression was used to evaluate possible predictors of symptom resolution. BD was the indication for cholecystectomy in 20% of patients (44 of 212). Short-term outcome was not predicted by any of the collected variables. An EF ≤11% predicted higher rate of symptom resolution (P=0.02). Although patients with specific right upper quadrant pain had higher rates of long-term improvement than those with nonspecific abdominal pain (57.9% vs. 18.2%), this did not reach significance (P=0.057). The only predictor emerging from the logistic regression was EF cutoff at 11% (odds ratio=17.5; 95% confidence interval, 1.756-174.418). In this series, symptoms of BD were more likely to be resolved by cholecystectomy in children with EF ≤11%.
