Clinical Characteristics and Risk Factors for Symptomatic Pediatric Gallbladder Disease
ABSTRACT Our center previously reported its experience with pediatric gallbladder disease and cholecystectomies from 1980 to 1996. We aimed to determine the current clinical characteristics and risk factors for symptomatic pediatric gallbladder disease and cholecystectomies and compare these findings with our historical series.
Retrospective, cross-sectional study of children, 0 to 18 years of age, who underwent a cholecystectomy from January 2005 to October 2008.
We evaluated 404 patients: 73% girls; 39% Hispanic and 35% white. The mean age was 13.10 ± 0.91 years. The primary indications for surgery in patients 3 years or older were symptomatic cholelithiasis (53%), obstructive disease (28%), and biliary dyskinesia (16%). The median BMI percentile was 89%; 39% were classified as obese. Of the patients with nonhemolytic gallstone disease, 35% were obese and 18% were severely obese; BMI percentile was 99% or higher. Gallstone disease was associated with hemolytic disease in 23% (73/324) of patients and with obesity in 39% (126/324). Logistic regression demonstrated older age (P = .019) and Hispanic ethnicity (P < .0001) as independent risk factors for nonhemolytic gallstone disease. Compared with our historical series, children undergoing cholecystectomy are more likely to be Hispanic (P = .003) and severely obese (P < .0279).
Obesity and Hispanic ethnicity are strongly correlated with symptomatic pediatric gallbladder disease. In comparison with our historical series, hemolytic disease is no longer the predominant risk factor for symptomatic gallstone disease in children.
- SourceAvailable from: Shawn D St. Peter
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- "There appears to an increase in the number of children requiring cholecystectomy for symptomatic biliary conditions  . Laparoscopic cholecystectomy (LC) is the gold standard therapy for both adults and children with symptomatic cholelithiasis (SC) and biliary dyskinesia (BD). "
ABSTRACT: Although the safety of same day discharge (SDD) after laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis (SC) and biliary dyskinesia (BD) in adults has been well documented in the literature, the same data in the pediatric population are lacking. We have recently instituted a protocol for SDD after LC for SC and BD, and this study is an analysis of our initial experience. A retrospective chart review of all patients who underwent LC for BD and SC in our institution from January 2011-July 2014 was performed. A total of 227 LC were performed for SC and BD during the study period. Approximately 25% (n = 57) of patients were in the SDD group. The remaining 75% (n = 170) of patients were admitted at least overnight stay (ONS) for the following reasons: medical 16.5% (n = 28), surgery ending too late 4.1% (n = 7), or clinical care habits 79.4% (n = 135). Comparing the SDD group with ONS group, no differences were found in the complication rate, readmissions, or follow up before scheduled appointment. Length of stay was significantly less for the SDD group than for the ONS. A trend for more SDDs was observed as time elapsed from initiation of the protocol. Also, earlier completion of surgery trended toward SDD. SDD appears safe for pediatric patients undergoing LC for BD or SC. The main obstacles to discharge were time of surgery completion and clinical care habits, both of which improved as comfort level with SDD grew among the staff. Copyright © 2015 Elsevier Inc. All rights reserved.Journal of Surgical Research 02/2015; 195(2). DOI:10.1016/j.jss.2015.02.024 · 2.12 Impact Factor
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- "Gallstones are increasingly found in childhood, not only because of the use of ultrasonography in the workup of abdominal pain but also because of the increase of incidence in obesity worldwide and the high frequency of hemolytic anemias in all countries     . "
ABSTRACT: Gallstones and cholelithiasis are being increasingly diagnosed in children owing to the widespread use of ultrasonography. The treatment of choice is cholecystectomy, and routine intraoperative cholangiography is recommended to explore the common bile duct. The objectives of this study were to describe our experience with the management of gallstone disease in childhood over the last 18 years and to propose an algorithm to guide the approach to cholelithiasis in children based on clinical and ultrasonographic findings.Journal of Pediatric Surgery 11/2012; 47(11):2033-8. DOI:10.1016/j.jpedsurg.2012.06.010 · 1.31 Impact Factor
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ABSTRACT: Evaluation of the child with acute abdominal pain is challenging because of the wide range of potential diagnoses. Presenting symptoms, clinical examination, and laboratory findings can guide selection of diagnostic imaging. Intussusception and intestinal malrotation are potentially serious causes of intestinal obstruction, which are best evaluated by ultrasound and upper gastrointestinal series, respectively. Ultrasound has diagnostic importance in the evaluation of multiple diseases, including appendicitis, by potentially decreasing the need for inpatient observation, cholecystitis and complications of gall stones such as pancreatitis, and ovarian diseases. Pelvic inflammatory disease should be considered in evaluation of a teenage girl with lower abdominal pain. Less common causes of acute abdominal pain include ingested foreign bodies, infected congenital anomalies, and perforated peptic ulcer disease. Presenting symptoms and physical examination findings can narrow the number of potential diagnoses in pediatric acute abdominal pain and thereby guide diagnostic imaging selection. Abdominal/pelvic ultrasound, rather than computed tomography scan, is the preferred modality for initial evaluation of many potential causes of pediatric abdominal pain.Current opinion in pediatrics 03/2012; 24(3):357-64. DOI:10.1097/MOP.0b013e328352704e · 2.74 Impact Factor