TY - JOUR
T1 - Laparoscopic cholecystectomy for biliary dyskinesia in children
T2 - Frequency increasing
AU - Lacher, Martin
AU - Yannam, Govardhana R.
AU - Muensterer, Oliver J.
AU - Aprahamian, Charles J.
AU - Haricharan, Ramanath N.
AU - Perger, Lena
AU - Bartle, Donna
AU - Talathi, Sonia S.
AU - Beierle, Elizabeth A.
AU - Anderson, Scott A.
AU - Chen, Mike K.
AU - Harmon, Carroll M.
PY - 2013/8
Y1 - 2013/8
N2 - 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.
AB - 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.
KW - Biliary dyskinesia
KW - Cholecystectomy
KW - Ejection fraction
KW - Outcome
KW - Therapy
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U2 - 10.1016/j.jpedsurg.2012.08.036
DO - 10.1016/j.jpedsurg.2012.08.036
M3 - Article
C2 - 23932611
AN - SCOPUS:84881448938
SN - 0022-3468
VL - 48
SP - 1716
EP - 1721
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 8
ER -