Optimal timing of cholecystectomy in children with gallstone pancreatitis

• Published in: The Journal of surgical research 2017-07, Vol.215, p.225-230
• Main Authors: Badru, Faidah, MD, MPH, Saxena, Saurabh, MD, Breeden, Robert, MS, Bourdillon, Maximillan, MS, Fitzpatrick, Colleen, MD, Chatoorgoon, Kaveer, MD, Greenspon, Jose, MD, Villalona, Gustavo, MD
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Child; Child, Preschool; Cholecystectomy; Cholecystectomy - methods; Female; Follow-Up Studies; Gallstone pancreatitis; Gallstones - complications; Gallstones - surgery; Humans; Infant; Male; Pancreatitis - etiology; Pancreatitis - surgery; Patient Readmission - statistics & numerical data; Pediatric cholecystectomy; Recurrence; Retrospective Studies; Surgery; Time Factors; Treatment Outcome
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2017.03.045

Abstract Background Little data exist regarding the recurrence of pancreatitis in pediatric patients with gallstone pancreatitis awaiting cholecystectomy. This study evaluates the recurrence rate of pancreatitis after acute gallstone pancreatitis based on the timing of cholecystectomy in pediatric patients. Materials and methods A retrospective chart review of all patients admitted with gallstone pancreatitis from 2007 to 2015 was performed. Children were divided into the following five groups. Group 1 had surgery during the index admission. Group 2 had surgery within 2 wk of discharge. Group 3 had surgery between 2 and 6 wk postdischarge. Group 4 had surgery 6 wk after discharge, and group 5 patients had no surgery. The recurrence rates of pancreatitis were calculated for all groups. Results Forty-eight patients with gallstone pancreatitis were identified in this study. The 19 patients in group 1 had no recurrence of their pancreatitis. Of the remaining 29 patients, nine (31%) had recurrence of pancreatitis or required readmission for abdominal pain prior to their cholecystectomy. In group 2, two of the eight patients (25%) had recurrent pancreatitis. In group 3, three of eight patients (37.5%) developed recurrent pancreatitis. In group 4, three of five patients (60%), and in group 5, one of eight. No children in group 5 had demonstrable gallstones at presentation, only sludge in their gallbladder. Conclusions Cholecystectomy during the index admission is associated with no recurrence or readmission for pancreatitis. Therefore, we recommend that cholecystectomy be performed after resolution of an episode of gallstone pancreatitis during index admission.