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Surgical management of gallstone pancreatitis in children
E Marty Knott1, Alessandra C Gasior, Jai Bikhchandani
1The Children's Mercy Hospital, Kansas City, Missouri 64108, USA.
Insights
Performing cholecystectomy during the initial hospitalization for pediatric gallstone pancreatitis may reduce overall hospital stay. This approach is recommended for children, mirroring adult guidelines.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Biliary Tract Disease
Background:
- Gallstone pancreatitis is rare in children, leading to varied treatment approaches.
- Understanding practice variations is crucial for optimizing outcomes in pediatric patients.
Purpose of the Study:
- To evaluate the impact of surgical timing on outcomes for pediatric gallstone pancreatitis.
- To compare outcomes between immediate and delayed cholecystectomy in children.
Main Methods:
- Retrospective review of pediatric patients with gallstone pancreatitis from 2000-2011.
- Comparison of outcomes (length of stay, morbidity) between immediate (Group 1) and delayed (Group 2) cholecystectomy.
Main Results:
- 41 pediatric patients underwent cholecystectomy for gallstone pancreatitis.
- Immediate cholecystectomy (Group 1) showed a trend towards shorter total hospital days (8.9 vs. 14.0 days).
- Delayed cholecystectomy (Group 2) had a higher rate of readmission for recurrent pancreatitis before surgery (36.8%).
Conclusions:
- This study is the largest series of pediatric cholecystectomy for gallstone pancreatitis.
- Laparoscopic cholecystectomy during initial hospitalization is supported for pediatric gallstone pancreatitis.
- Early surgical intervention may decrease total hospital stay and prevent recurrent pancreatitis episodes.
Introduction:
Because of the low incidence of gallstone pancreatitis in children, we sought to examine effects of varied practice patterns on outcomes.
Subjects And Methods:
A retrospective review was performed on all patients undergoing cholecystectomy for a diagnosis of gallstone pancreatitis from January 2000 to June 2011. Demographics, diagnostic strategies, operative approaches, length of stay, and morbidity were compared between Group 1, who had cholecystectomy performed during the admission of diagnosis, and Group 2, who underwent cholecystectomy subsequently.
Results:
Cholecystectomy was performed for gallstone pancreatitis in 41 patients, of whom 29 (70.7%) patients were female. Ultrasound was performed in all cases, revealing cholelithiasis in 37 (90.2%). There were 22 patients in Group 1 and 19 in Group 2. Mean age and body mass index did not vary between groups. Endoscopic retrograde cholangiopancreatography was performed in 14 patients (8 in Group 1 and 6 in Group 2), of these procedures 11 were prior to cholecystectomy, 2 were after cholecystectomy, and 1 was both. Total number of hospital days attributed to the diagnosis of gallstone pancreatitis was 8.9 ± 6.5 in Group 1 compared with 14.0 ± 14.4 in Group 2 (P = .15). There were 7 patients (36.8%) in Group 2 who required readmission for recurrent pancreatitis prior to their operation.
Conclusions:
This represents the largest reported series of cholecystectomy for gallstone pancreatitis in children. Our results support the use of laparoscopic cholecystectomy during the initial hospitalization as is recommended in the adult literature, and this approach may decrease the total hospital stay.
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