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Cholecystectomy in the Pediatric Population-What Has Changed in Recent Decades? Insight from a Tertiary Pediatric
Tal Weiss1,2,3, Yael Dreznik2,4, Dragan Kravarusic2,4
1Department of Epidemiology and Preventive Medicine, School of Public Health, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6139001, Israel.
Insights
Pediatric cholecystectomies for non-hemolytic gallstones remained stable, unlike Western trends. Hemolysis-related disease is a key indication, with higher complication rates in symptomatic patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hepatology
Background:
- Symptomatic cholelithiasis is the primary reason for pediatric cholecystectomy.
- While historically linked to hemolytic disorders, non-hemolytic gallbladder disease in children is increasingly prevalent.
Purpose of the Study:
- To analyze indications and temporal trends of pediatric cholecystectomies in Israel.
- To compare clinical presentations between hemolysis-related and non-hemolysis-related cases.
Main Methods:
- Retrospective observational cohort study of pediatric patients (≤19 years) undergoing cholecystectomy from 2011-2024.
- Exclusion of patients with congenital biliary tract anomalies or neoplasms.
Main Results:
- 199 cholecystectomies performed; 34.2% were hemolysis-related.
- Non-hemolysis-related cholecystectomies showed stable temporal trends.
- Higher choledocholithiasis rates in hemolysis-related group (27% vs. 7.9%).
Conclusions:
- Pediatric non-hemolysis-related cholecystectomies did not increase over time in this Israeli cohort.
- Hemolysis-related disease remains a significant indication for pediatric cholecystectomy.
- Prophylactic surgery may benefit hemolysis patients; symptomatic cases have high complication rates.
Background:
Symptomatic cholelithiasis is the leading indication for pediatric cholecystectomy. While historically linked to hemolytic disorders, non-hemolytic gallbladder disease in children has become increasingly common in recent decades.
Objective:
The objective of this study was to describe the distribution and temporal trends of indications for cholecystectomy among children (ages ≤ 19 years) undergoing surgery at a tertiary pediatric center in Israel and to compare clinical presentation between hemolysis-related and non-hemolysis-related cases.
Methods:
We conducted a retrospective observational cohort study of all pediatric patients who underwent cholecystectomy at Schneider Children's Medical Center between 2011 and 2024. Patients with congenital biliary tract anomalies or biliary tract neoplasms were excluded.
Results:
A total of 199 cholecystectomies were performed (median age 13.4 years). Hemolysis-related cholelithiasis accounted for 34.2% of cases; five patients (2.5%) had gallbladder polyps or other benign lesions, while the remaining patients had non-hemolysis-related cholelithiasis. No cases of biliary dyskinesia were identified. The proportion of non-hemolysis-related cholecystectomies remained stable over time. Among symptomatic patients, the rate of choledocholithiasis was significantly higher in the hemolysis-related group compared to the non-hemolysis group (27% vs. 7.9%, p = 0.004). No statistically significant association was observed between obesity and increased disease severity or adverse outcomes.
Conclusion:
Unlike trends reported in some Western countries, the number of cholecystectomies performed for non-hemolysis-related cholelithiasis in our single-center cohort did not increase over time. Hemolysis-related disease remains a leading indication for pediatric cholecystectomy. Prophylactic surgery may help prevent biliary complications in this group while symptomatic patients have substantial complication rates.
