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Timing of Cholecystectomy in Children With Biliary Pancreatitis
Tom K Lin1, Joseph J Palermo, Jaimie D Nathan
1*Division of Pediatric Gastroenterology, Hepatology and Nutrition †Division of Pediatric Surgery ‡Division of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Early cholecystectomy (CCE) in children with biliary pancreatitis (BP) is safe and reduces adverse events. Delayed surgery increases the risk of pancreatitis recurrence or biliary colic.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
Background:
- Biliary pancreatitis (BP) is a common condition in pediatric patients.
- Cholecystectomy (CCE) is the standard treatment to prevent pancreatitis recurrence.
- Optimal timing for CCE in children remains debated, with limited pediatric data.
Purpose of the Study:
- To evaluate the safety and efficacy of early versus delayed CCE in pediatric patients with BP.
- To compare adverse event rates between early and delayed CCE in children.
Main Methods:
- Retrospective chart review of pediatric patients with BP over 45 months.
- Categorization of CCE timing into 'early' (index admission) and 'late' (subsequent admission).
- Analysis of patient demographics and adverse events related to CCE timing.
Main Results:
- Nineteen pediatric patients with BP and subsequent CCE were identified.
- Nine patients underwent early CCE with no adverse events.
- Ten patients underwent delayed CCE, experiencing 4 adverse events (pancreatitis recurrence or biliary colic).
Conclusions:
- Delayed CCE in children with mild BP is associated with a higher rate of adverse biliary-related events.
- Early CCE is a safe and effective intervention for pediatric patients with mild BP.
Background:
Biliary pancreatitis (BP) is common in adults and children. Current standard of care is to perform a cholecystectomy (CCE) to decrease the recurrence risk of pancreatitis. Controversy exists as to the timing of surgery, early versus delayed surgical intervention. Adult literature suggests a greater benefit of early CCE. Comparatively, there is limited pediatric literature as to the optimal timing of a CCE in children. We report a retrospective case series of children with BP who underwent early versus late CCE.
Methods:
A retrospective chart review was performed of children with BP for a period of 45 months. Reviewed information included patient demographics, timing of CCE, and the occurrence of adverse events preceding or following surgical intervention. Early CCE was defined as surgery during the index admission; late CCE was defined as surgery during a subsequent admission.
Results:
Nineteen children and adolescents (17 girls) were identified to have had BP with a subsequent CCE. Cholecystectomy was performed early in 9 patients with no adverse events. Ten patients had delayed surgery with 4 occurrences of adverse clinical events (recurrence of pancreatitis or biliary colic abdominal pain) while awaiting their CCE.
Conclusions:
Adverse biliary-related events occur at a higher rate in children with mild BP who undergo a delayed CCE when compared to early CCE performance. Early CCE is safe to perform in children with mild BP.
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