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Outcomes of Laparoscopic Cholecystectomy for Biliary Dyskinesia in Children
Sarah W Lai1,2, Steven S Rothenberg2, Saundra M Kay2
11 Alberta Children's Hospital , Calgary, Alberta, Canada .
Insights
Laparoscopic cholecystectomy effectively resolves symptoms in children with biliary dyskinesia. Factors like a virgin abdomen and shorter follow-up correlate with improved outcomes in pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Biliary dyskinesia is a functional gallbladder disorder causing abdominal pain in children.
- Gallbladder ejection fraction (EF) <35% or pain with cholecystokinin (CCK) stimulation on cholescintigraphy defines biliary dyskinesia.
- Laparoscopic cholecystectomy is a common treatment, but its outcomes in pediatric populations require further evaluation.
Purpose of the Study:
- To assess the safety and efficacy of laparoscopic cholecystectomy for treating biliary dyskinesia in pediatric patients.
- To identify factors associated with successful symptom resolution after surgery.
Main Methods:
- A retrospective chart review of 215 children (<21 years) diagnosed with biliary dyskinesia and treated with laparoscopic cholecystectomy.
- Data collected included demographics, diagnostic imaging (EF, CCK response), pathology, and symptom resolution.
- Outcomes were analyzed based on symptom improvement, postoperative complications, and associated factors.
Main Results:
- Laparoscopic cholecystectomy led to symptom improvement in 89.5% of pediatric patients.
- Chronic cholecystitis was a common finding (85.9%) on pathology.
- Factors associated with better outcomes included a virgin abdomen (OR 4.03) and follow-up less than 6 months (OR 7.35).
- Postoperative complications were low, including wound infections (3.3%) and need for common bile duct stents (4.4%).
Conclusions:
- Laparoscopic cholecystectomy is a safe and effective treatment for symptom relief in children with biliary dyskinesia.
- A virgin abdomen and shorter follow-up periods are linked to superior outcomes.
- Further prospective, long-term studies are needed to compare surgical versus nonoperative management for biliary dyskinesia.
Purpose:
To determine the outcomes of laparoscopic cholecystectomy as a treatment for biliary dyskinesia in children.
Methods:
With ethics approval, a retrospective chart review was performed on children (<21 years) at a single center diagnosed with biliary dyskinesia (defined as gallbladder ejection fraction [EF] <35% and/or pain with cholecystokinin [CCK] on cholescintigraphy, in the absence of gallstones or cholecystitis on ultrasound) and treated with laparoscopic cholecystectomy between March 2010 and February 2016. Demographic, medical history, diagnostic imaging, pathology, and outcome data were collected and analyzed based on degree of symptom resolution.
Results:
Laparoscopic cholecystectomy was performed in 215 children with biliary dyskinesia (156/215 [72.6%] female, age 13.8 ± 3.4 years, body mass index [BMI] 22.3 ± 6.3 kg/m2). 181/206 (87.9%) had EF <35%. CCK reproduced symptoms in 149/177 (84.2%). 34/215 (15.8%) were lost to follow-up. Median follow-up time was 2.7 weeks. Pain improved in 162/181 (89.5%). Chronic cholecystitis was found in 183/213 (85.9%) and unexpected cholelithiasis in 4/213 (1.9%) on pathology. Postoperatively, 6/181 (3.3%) had wound infections and 8/181 (4.4%) required common bile duct stents for the following indications: 6 sphincter of Oddi dysfunction, 1 choledocholithiasis, and 1 stricture. Virgin abdomen (odds ratio [OR] 4.03, confidence interval [95% CI] 1.12-14.53, P = .0460) and follow-up <6 months (OR 7.35, 95% CI 2.68-20.21, P = .0002) were associated with better outcomes.
Conclusions:
Laparoscopic cholecystectomy is safe and effective in symptom resolution for biliary dyskinesia in children. Virgin abdomen and follow-up <6 months were associated with better outcomes. Prospective long-term studies comparing surgical and nonoperative management of biliary dyskinesia are required to determine the utility of cholecystectomy.
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