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Cholecystectomy in children: indications, clinical, laboratory and histopathological findings and cost analysis
Aysel Ünlüsoy Aksu1, Nebiyye Genel2, Gülseren Şahin1
1Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Türkiye.
Insights
Routine histopathological examination of gallbladders in children undergoing cholecystectomy offers minimal diagnostic value. Selective examination can reduce healthcare costs and pathologist workload, improving efficiency in pediatric surgical care.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pathology
Background:
- Cholelithiasis is the primary indication for cholecystectomy in children.
- Routine histopathological examination of all gallbladder specimens is standard practice.
- Selective examination is proposed due to low gallbladder cancer rates in adults, prompting evaluation in pediatric cases.
Purpose of the Study:
- To assess indications, clinical, laboratory, and histopathological findings in pediatric cholecystectomies.
- To evaluate the contribution and cost-effectiveness of routine histopathological examination in pediatric diagnosis and treatment.
Main Methods:
- Retrospective analysis of 114 children who underwent cholecystectomy between 2008 and 2022.
- Evaluation of clinical, laboratory, imaging, and histopathological data.
Main Results:
- Cholelithiasis (71%) was the most common diagnosis, followed by choledochal malformation (15.8%).
- Significant histopathological findings were rare (2.6%), including adenomyomatosis, angiodysplasia, and pyloric metaplasia.
- Routine histopathology costs represent a small fraction of the overall procedure and minimum wage.
Conclusions:
- Histopathological examination provides limited contribution to diagnosis and management in pediatric cholecystectomy.
- Selective gallbladder histopathological examination in children can decrease healthcare expenses and save pathologist time.
Background:
The most common indication for cholecystectomy in children is cholelithiasis, and routine histopathological examination is performed on all gallbladder specimens. Currently, selective histopathological examination is suggested instead of routine examination due to the low frequency of gallbladder cancer in adults. The purpose of this study was to evaluate the indications, clinical, laboratory and histopathological findings of the cholecystectomy in children. We also questioned the contribution and cost-effectiveness of routine histopathological evaluation in diagnosis and treatment.
Methods:
A total of 114 children underwent cholecystectomy between the years 2008 and 2022. The clinical findings, laboratory, and imaging results of the patients and histopathological findings of the gallbladder specimens were evaluated retrospectively.
Results:
Cholelithiasis were diagnosed in 71%, choledochal malformation in 15.8%, hydrops of gallbladder and/or biliary sludge in 12.3%, and hypoplasia of gallbladder in 0.9% of the patients. Histopathologically significant findings were observed in only 3 patients (2.6%); adenomyomatosis in 2 and angiodysplasia and pyloric metaplasia in 1. While the cost of a cholecystectomy and histopathologic examination combined amounted to 27.77% of the minimum wage in Türkiye in 2024, the histopathologic examination alone constitutes just 0.67% of the minimum wage and 2.4% of the operation fee.
Conclusion:
In children undergoing cholecystectomy, histopathological examination does not provide any significant contribution to the patient's diagnosis and follow-up management. In children, selective gallbladder histopathological examination might reduce health costs and save time for pathologists.
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