Laparoscopic cholecystectomy for biliary dyskinesia in children: Frequency increasing

• Published in: Journal of pediatric surgery 2013-08, Vol.48 (8), p.1716-1721
• Main Authors: Lacher, Martin, Yannam, Govardhana R, Muensterer, Oliver J, Aprahamian, Charles J, Haricharan, Ramanath N, Perger, Lena, Bartle, Donna, Talathi, Sonia S, Beierle, Elizabeth A, Anderson, Scott A, Chen, Mike K, Harmon, Carroll M
• Format: Article
• Language: English
• Subjects: Adolescent; Biliary dyskinesia; Biliary Dyskinesia - complications; Biliary Dyskinesia - surgery; Child; Child, Preschool; Cholecystectomy; Cholecystectomy, Laparoscopic - trends; Cholecystectomy, Laparoscopic - utilization; Cholecystitis - complications; Cholecystitis - surgery; Ejection fraction; Female; Follow-Up Studies; Gallbladder - secretion; Humans; Male; Obesity - complications; Outcome; Pediatrics; Surgery; Surveys and Questionnaires; Symptom Assessment; Therapy; Treatment Outcome; Young Adult
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2012.08.036

Abstract Purpose The treatment of children with biliary dyskinesia (BD) is controversial. As we recently observed an increasing frequency of referrals for BD in our institution the aim of the study was to re-evaluate the long-term outcome in children with BD. Methods Children with laparoscopic cholecystectomy (LC) for suspected BD between 8/2006 and 5/2011 were included. A pathologic ejection fraction (EF) was defined as < 35%. The long-term effect of cholecystectomy was assessed via a Likert scale symptom questionnaire. Results 82 children (median age 13.5 years, mean BMI 25.8) were included. CCK-HIDA scan was pathologic in 74 children (90.2%). Mean EF was 16.4%. Histology revealed chronic cholecystitis in 48 (58.5%) children and was normal in 30 children (36.5%). The frequency of LC for suspected BD increased by a factor of 4.3 in the last 10 years. Long term follow-up showed that only 23/52 children (44.2%) were symptom-free after LC. Patients with chronic inflammation were more likely to have persistent symptoms (p = 0.017). An EF < 15% was associated with a resolution of symptoms (p = 0.031). Conclusion The frequency of LC for suspected BD in our institution has increased significantly during recent years. The long-term efficacy in our cohort was only 44.2%. We believe that laparoscopic cholecystectomy is likely helpful in patients with an EF < 15%. However, in children with an EF of 15%–35%, based upon our data, we would highly recommend an appropriately thorough pre-op testing to exclude other gastrointestinal disorders prior to consideration of operative management.