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Multi-institutional analysis of long-term symptom resolution after cholecystectomy for biliary dyskinesia in children
E Marty Knott1, Frankie B Fike, Alessandra C Gasior
1Children's Mercy Hospital, Kansas City, MO, USA.
Insights
Early symptom relief after cholecystectomy for biliary dyskinesia in children doesn't guarantee long-term success. Many children with persistent pain still value the surgery, as key indicators did not predict outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Biliary Tract Disorders
Background:
- Abdominal pain after cholecystectomy in children with biliary dyskinesia has variable outcomes.
- Understanding long-term symptom resolution is crucial for patient management.
Purpose of the Study:
- To compare early outcomes with long-term symptom resolution in pediatric patients who underwent cholecystectomy for biliary dyskinesia.
- To identify predictors of ongoing pain after surgery.
Main Methods:
- Retrospective chart review and telephone surveys of 105 pediatric patients (age 7.9-19 years) who had cholecystectomy for biliary dyskinesia between 2000-2011.
- Assessed demographics, short-term outcomes, and long-term symptom status via follow-up surveys.
Main Results:
- 76.1% of patients experienced symptom resolution at the postoperative visit.
- At a median follow-up of 3.7 years, 60.7% of surveyed patients reported no ongoing abdominal pain.
- Ejection fraction (EF), body mass index percentile (BMI%), and pain with cholecystokinin (CCK) were not predictive of ongoing pain.
Conclusions:
- Short-term symptom resolution post-cholecystectomy for biliary dyskinesia does not reliably predict long-term outcomes in children.
- Key clinical indicators like EF, BMI%, and CCK response do not predict symptom persistence.
- Most pediatric patients with persistent symptoms after cholecystectomy for biliary dyskinesia do not regret the procedure.
Purpose:
Current literature for resolution of abdominal pain after cholecystectomy in children with biliary dyskinesia shows variable outcomes. We sought to compare early outcomes with long-term symptom resolution in children.
Methods:
Telephone surveys were conducted on children who underwent cholecystectomy for biliary dyskinesia between January 2000 and January 2011 at two centers. Retrospective review was performed to obtain demographics and short-term outcomes.
Results:
Charts of 105 patients' age 7.9-19 years were reviewed; 80.9 % were female. All were symptomatic with an ejection fraction (EF) <35 % or pain with cholecystokinin administration. At the postoperative visit, 76.1 % had resolution of symptoms. Fifty-six (53.3 %) patients were available for follow-up at median 3.7 (1.1-10.7) years. Of these, 34 (60.7 %) reported no ongoing abdominal pain. Of the 22 patients with persistent symptoms, satisfaction score was 7.3 ± 2.7 (scale of 1-10) and 19 (86.4 %) were glad that they had a cholecystectomy performed. EF, body mass index percentile (BMI %), and pain with cholecystokinin (CCK) were not predictive of ongoing pain at either follow-up periods.
Conclusion:
Short-term symptom resolution in children undergoing cholecystectomy for biliary dyskinesia is not reflective of long-term results. Neither EF, BMI % nor pain with CCK was predictive of symptom resolution. The majority of patients with ongoing complaints do not regret cholecystectomy.
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