Outcomes After Laparoscopic Cholecystectomy in Children With Biliary Dyskinesia

Abstract

Our objectives were to determine the prevalence of biliary dyskinesia (BD) as an indication for cholecystectomy in children and to identify presenting clinical findings and optimal ejection fraction (EF) associated with the resolution of symptoms after surgery. We conducted a retrospective review of medical records of 212 pediatric patients who underwent cholecystectomy from August, 1998 to November, 2006. Patients who met criteria for BD had their short-term outcomes examined by record review and their long-term postoperative outcomes recorded by questionnaire. To compare EF and clinical presentation to symptom resolution or outcome, χ tests were used. Logistic regression was used to evaluate possible predictors of symptom resolution. BD was the indication for cholecystectomy in 20% of patients (44 of 212). Short-term outcome was not predicted by any of the collected variables. An EF ≤11% predicted higher rate of symptom resolution (P=0.02). Although patients with specific right upper quadrant pain had higher rates of long-term improvement than those with nonspecific abdominal pain (57.9% vs. 18.2%), this did not reach significance (P=0.057). The only predictor emerging from the logistic regression was EF cutoff at 11% (odds ratio=17.5; 95% confidence interval, 1.756-174.418). In this series, symptoms of BD were more likely to be resolved by cholecystectomy in children with EF ≤11%.

Biliary Dyskinesia and Symptomatic Gallstone Disease in Children: Two Sides of the Same Coin?

“…While the results favored cholecystectomy, the control group did not receive any active therapy and did not show any improvement, a highly unusual finding in functional disorders [13]. The results also differ from reported outcomes in BD, which are more variable with decreasing success rates after longer follow-up time and which include response rates exceeding 50 % in patients who did not undergo surgery [12, 14–28]. …”

Prediction of symptom improvement in children with biliary dyskinesia

“…Given the increase in the incidence of cholecystectomy for biliary dyskinesia, there is interest in identifying predictive factors to determine which pediatric patients are more likely to benefit from cholecystectomy. Predictive factors for long-term symptom improvement after cholecystectomy for biliary dyskinesia have not been consistently identified [6,8,9]. One study has suggested that obese patients are less likely to derive benefit from cholecystectomy [16], but in the present study, obese patients were equally as likely as nonobese patients to benefit from cholecystectomy at early and long-term follow-up.…”

“…Existing literature supports several different EF cutoffs to diagnose biliary dyskinesia [4,9,12,17,19,20]. In children, HIDA scans have only been reported to be predictive of symptom relief in patients with very low EFs [8,9,16,21,22]. Our study also investigated the ability of FUS to diagnose biliary dyskinesia.…”

“…Existing studies have demonstrated symptom relief on short-term follow-up in patients undergoing cholecystectomy for biliary dyskinesia, but few studies have evaluated pain improvement or symptom relief on long-term follow-up [6,8,9]. Other studies have demonstrated inconsistent accuracy of cholecystokinin-stimulated hepatobiliary iminodiacetic acid (HIDA) scans in identifying patients who will have symptom improvement after cholecystectomy [8,9].…”

“…Other studies have demonstrated inconsistent accuracy of cholecystokinin-stimulated hepatobiliary iminodiacetic acid (HIDA) scans in identifying patients who will have symptom improvement after cholecystectomy [8,9]. The purpose of this study was (1) to determine the preoperative characteristics associated with short-term and long-term symptom improvement in children who undergo cholecystectomy for biliary dyskinesia and (2) to evaluate the ability of the gallbladder ejection fraction (EF), as measured by cholecystokinin-stimulated HIDA scan or fatty meal ultrasound (FUS), to predict short-term and long-term pain improvement in these pediatric patients.…”