Abstract
Gallbladder disorders have been recognized with increasing frequency in pediatric patients. This study aimed to identify recent trends in management and compare the effectiveness of laparoscopic (LC) over open cholecystectomy (OC) by a retrospective chart analysis of all cholecystectomies from 1990 through 1995. Information obtained included demographics, symptoms, predisposing conditions, associated illnesses, family history, imaging studies, type of cholecystectomy, complications, operative time, pain medication, diet recommencement, pathologic findings, and length of hospital stay. The type of cholecystectomy (OC vs. LC) was compared with the clinical variables using standard statistics. Eighty-three patients between 21 months and 18 years of age were identified; their mean age was 14.8 years. Females (76%) with classic biliary symptoms predominated; 12% of the patients developed gallstone pancreatitis and 7% jaundice. Abnormal liver chemistry values, obesity, and elevated triglyceride levels comprised the most significant predisposing factors. Indications for surgery were cholelithiasis in 71 patients (86%), gallbladder dyskinesia in 10 (12%), and sludge/polyp in 2. Fifty-nine cholecystectomies (71%) were done laparoscopically and 24 (29%) open. Choledocholithiasis in 6 children (7%) was managed by open extraction with t-tube placement or endoscopic papillotomy followed by LC. No major ductal complication was identified. The predominant pathologic finding was chronic cholecystitis, including the subgroup with biliary dyskinesia. Statistical comparison showed that LC is superior to OC in regard to length of stay, diet resumption, use of pain medication, operating time, and cosmetic results. It is concluded that a contemporary diet, obesity, and abnormal liver chemistry are the main predisposing conditions of gallbladder disease in children in this decade. Females in their teenage years with typical symptoms continue to be the most commonly affected group. Persistent biliary symptoms associated with low gallbladder ejection fractions during hepatobiliary cholecystokinin-stimulated scans can be caused by dyskinesia. The method of choice to remove the diseased gallbladder in children is LC; which is safe, efficient, and superior to the conventional method. Common duct stones can be managed by simultaneous endoscopic papillotomy. The costs of LC are reduced by employing reusable equipment and selective cholangiographic indications.
Similar content being viewed by others
References
Kirtley JA, Holcomb GW (1996) Surgical management of diseases of the gallbladder and common duct in children and adolescents. Am J Surg 111: 39–46
Sigman HH, Laberge JM, Croitoru D, Hong A, Sigman K, Nguyen LT, Guttman FM (1991) Laparoscopic cholecystectomy: a treatment option for gallbladder disease in children. J Pediatr Surg 26: 1181–1183
Newman KD, Marmon LM, Attorri R, Evans S (1991) Laparoscopic cholecystectomy in pediatric patients. J Pediatr Surg 26: 1184–1185
Holcomb III GW, Sharp KW, Neblett III WW, Morgan WM, Pietsch IB (1994) Laparoscopic cholecystectomy in infants and children: modifications and cost analysis. J Pediatr Surg 29: 900–904
Rescorla FJ, Grosfeld JL (1992) Cholecystitis and cholelithiasis in children. Semin Pediatr Surg 1: 98–106
Grosfeld JL, Rescorla FJ, Skinner MA, West KW, Scherer LR (1994) The spectrum of biliary tract disrorders in infants and children. Arch Surg 129: 513–520
Hogan WJ, Geene JE (1998) Biliary dyskinesia. Endoscopy 20: 179–183
Atkins HL, Oster ZH (1989) Asymmetric gallbladder contraction following cholecystokinin hepatobiliary imaging. Clin Nucl Med 14: 82–86
Andrassy RJ, Treadwell TA, Ratner IA, Buckley CJ (1976) Gallbladder disease in children and adolescents. Am J Surg 132: 10–12
Lau GE, Andrassy RJ, Mahour GH (1983) A 30-year review of the management of gallbladder disease at a children's hospital. Am Surg 49: 411–413
Greenberg M, Kangarloo H, Cochran ST, Sample WF (1980) The ultrasonographic diagnosis of cholecystitis and cholelithiasis in children. Ultrasound 745–749
Hanson BA, Mahour GH, Woolley MM (1971) Diseases of the gallbladder in infancy and childhood. J Pediatr Surg 6: 277–283
Johnson RG, Longino LA (1971) Cholelithiasis and cholecystitis in children. Am Surg 37: 651–652
MacMillan, Schullinger JN, Santulli TV (1974) Cholelithiasis in childhood. Am J Surg 127: 689–692
Reif S, Sloven DG, Lebenthal (1991) Gallstones in children. Am J Dis Child 145: 105–108
Frey CF (1981) Gallstone pancreatitis. Surg Clin North Am 61: 923–938
Fenster LF, Lonborg R, Thirlby RC, Traverso LW (1995) What symptoms does cholecystectomy cure? Insights from an outcome measurement project and review of the literature. Am J Surg 169: 533–538
Shaffer EA, Small DM (1976) Gallstone disease: pathogenesis and management. Curr Probl Surg 113: 1–71
Holcomb GW, O'Neill JA, Holcomb GW III (1980) Cholecystitis, cholelithiasis and common duct stenosis in children and adolescents. Ann Surg 191: 626–635
Henschke CI, Teele RL (1983) Cholelithiasis in children: recent observations. J Ultrasound Med 2: 481–484
Pellerin D, Bertin P, Nihoul-Fekete CI, Ricour CL (1975) Cholelithiasis and ileal pathology in childhood. J Pediatr Surg 10: 35–41
Holcomb GW III (1993) Laparoscopic cholecystectomy. Semin Pediatr Surg 2: 159–167
Vinogard I, Halevy A (1992) Laparoscopic cholecystectomy in children. Harefuah 123(3–4): 89–91
Imhof M, Raunest J, Ohmann CH, Röher HD (1992) Acute acalculous cholecystitis complicating trauma: a prospective sonographic study. World J Surg 16: 1160–1166
Takiff H, Fonkalsrud EW (1984) Gallbladder disease in childhood. Am J Dis Child 138: 565–568
Grace PA, Poston GJ, Williamson RCN (1990) Biliary motility. Gut 31: 571–582
Misra DC, Blossom GB, Fink-Bennett D, Glover JL (1991) Results of surgical therapy for biliary dyskinesia. Arch Surg 126:957–960
Sorenson MK, Fancher S, Lang NP, (1993) Abnormal gallbladder nuclear ejection fraction predicts success of cholecystectomy in patients with biliary dyskinesia. Am J Surg 166: 672–675
Lugo-Vicente HL (1996) Gallbladder dyskinesia in children (submitted for publication)
Holcomb GW III, Olsen DO, Sharp KW (1991) Laparoscopic cholecystectomy in the pediatric patient. J Pediatr Surg 26: 1186–1190
Davidoff AM, Branum GD, Murray EA, Chong WK, Ware RE, Kinney TR, Pappas TN, Meyers WC (1992) The technique of laparoscopic cholecystectomy in children. Ann Surg 215: 186–191
Moir CR, Donohue JH, van Heerden JA (1992) Laparoscopic cholecystectomy in children: initial experience and recommendations. J Pediatr Surg 27: 1066–1070
Bailey PV, Connors RH, Tracy TF, Sotelo-Avila C, Lewis JE, Weber TR (1989) Changing spectrum of cholelithiasis and cholecystitis in infants and children. Am J Surg 158: 585–588
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lugo-Vicente, H.L. Trends in management of gallbladder disorders in children. Pediatr Surg Int 12, 348–352 (1997). https://doi.org/10.1007/BF01076936
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01076936