Ann Hepatobiliary Pancreat Surg.  2016 Nov;20(4):187-190. 10.14701/ahbps.2016.20.4.187.

Pediatric cholecystectomy for symptomatic gallstones unrelated to hematologic disorder

• Suh SG
• Choi YS
• Park KW
• Lee SE

• KMID: 2362469
• DOI: http://doi.org/10.14701/ahbps.2016.20.4.187

Abstract

BACKGROUNDS/AIMS
Gallstones are being increasingly diagnosed in pediatric patients. The purpose of this study was to determine characteristics of pediatric patients who underwent cholecystectomy because of symptomatic gallstone disease unrelated to hemolytic disorder.
METHODS
We reviewed cases of pediatric patients (under 18 years old) who underwent cholecystectomy between May 2005 and December 2015.
RESULTS
A total 20 pediatric patients (under 18 years old) underwent cholecystectomy during the study period. One patient was excluded because cholecystectomy was performed due to gall stones caused by hemolytic anemia. The 19 cases comprised 9 male (47.3%) and 10 female (52.7%) subjects. The mean age was 14.9 years (range, 5-18), and 66.7% of patients were older than 12 years of age. Mean body weight was 65.0 kg (range, 13.9-93.3), and mean body mass index was 21.7 kg/m2 (range, 12.3-35.1), with 26.37% of patients being overweight. All 19 patients underwent laparoscopic cholecystectomy. There were no postoperative complications and no mortality. Comparison between overweight and non-overweight patients indicated that significantly more overweight patients had cholesterol stones (5/5 vs. 7/14, p=0.036) and were classified as complicated disease (3/5 vs. 1/14, p=0.037).
CONCLUSIONS
The more frequent occurrence of complications such as choledocholithiasis or gallstone pancreatitis, in overweight patients indicates the need for more careful evaluation and management in these patients. Pediatricians and surgeons should always consider gallstone disease in pediatric patients despite difficulty in suspecting symptomatic gallstones in cases who present with abdominal pain that is rarely clear-cut.

Keyword

Cholecystectomy; Gallstone; Child; Overweight

MeSH Terms

Abdominal Pain
Anemia, Hemolytic
Body Mass Index
Body Weight
Child
Cholecystectomy*
Cholecystectomy, Laparoscopic
Choledocholithiasis
Cholesterol
Female
Gallstones*
Humans
Male
Mortality
Overweight
Pancreatitis
Postoperative Complications
Surgeons
Cholesterol

Reference

1. Bailey PV, Connors RH, Tracy TF Jr, Sotelo-Avila C, Lewis JE, Weber TR. Changing spectrum of cholelithiasis and cholecystitis in infants and children. Am J Surg. 1989; 158:585–588. PMID: 2511775.

2. Kang JY, Ellis C, Majeed A, Hoare J, Tinto A, Williamson RC, et al. Gallstones--an increasing problem: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther. 2003; 17:561–569. PMID: 12622765.

3. Balaguer EJ, Price MR, Burd RS. National trends in the utilization of cholecystectomy in children. J Surg Res. 2006; 134:68–73. PMID: 16650434.

4. Mehta S, Lopez ME, Chumpitazi BP, Mazziotti MV, Brandt ML, Fishman DS. Clinical characteristics and risk factors for symptomatic pediatric gallbladder disease. Pediatrics. 2012; 129:e82–e88. PMID: 22157135.

5. Wesdorp I, Bosman D, de Graaff A, Aronson D, van der Blij F, Taminiau J. Clinical presentations and predisposing factors of cholelithiasis and sludge in children. J Pediatr Gastroenterol Nutr. 2000; 31:411–417. PMID: 11045839.

6. Kaechele V, Wabitsch M, Thiere D, Kessler AL, Haenle MM, Mayer H, et al. Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex, and pubertal development. J Pediatr Gastroenterol Nutr. 2006; 42:66–70. PMID: 16385256.

7. Garey CL, Laituri CA, Keckler SJ, Ostlie DJ, Stagg HW, Little DC, et al. Laparoscopic cholecystectomy in obese and non-obese children. J Surg Res. 2010; 163:299–302. PMID: 20537352.

8. Kaye AJ, Jatla M, Mattei P, Kelly J, Nance ML. Use of laparoscopic cholecystectomy for biliary dyskinesia in the child. J Pediatr Surg. 2008; 43:1057–1059. PMID: 18558182.

9. Hofeldt M, Richmond B, Huffman K, Nestor J, Maxwell D. Laparoscopic cholecystectomy for treatment of biliary dyskinesia is safe and effective in the pediatric population. Am Surg. 2008; 74:1069–1072. PMID: 19062663.

10. Al-Homaidhi HS, Sukerek H, Klein M, Tolia V. Biliary dyskinesia in children. Pediatr Surg Int. 2002; 18:357–360. PMID: 12415355.

11. Palasciano G, Portincasa P, Vinciguerra V, Velardi A, Tardi S, Baldassarre G, et al. Gallstone prevalence and gallbladder volume in children and adolescents: an epidemiological ultrasonographic survey and relationship to body mass index. Am J Gastroenterol. 1989; 84:1378–1382. PMID: 2683739.

12. Nomura H, Kashiwagi S, Hayashi J, Kajiyama W, Ikematsu H, Noguchi A, et al. Prevalence of gallstone disease in a general population of Okinawa, Japan. Am J Epidemiol. 1988; 128:598–605. PMID: 3046339.

13. Kim HS, Nam SH, Kim DY, Kim SC, Kim IK. Laparoscopic cholecystectomy in children. J Korean Assoc Pediatr Surg. 2006; 12:213–220.

14. Eun HS, Baek SY, Chung KS. A clinical study for gall bladder stones in children. Korean J Pediatr Gastroenterol Nutr. 2005; 8:194–201.

15. Kim SY, Seo JK. Cholelithiasis in childhood. J Korean Pediatr Soc. 1994; 37:70–77.

16. Kim CS, Koo BH. Laparoscopic cholecystectomy in the pediatric patient. J Korean Surg Soc. 1993; 45:293–297.

17. Walker SK, Maki AC, Cannon RM, Foley DS, Wilson KM, Galganski LA, et al. Etiology and incidence of pediatric gallbladder disease. Surgery. 2013; 154:927–931. PMID: 24074432.

18. Lacher M, Yannam GR, Muensterer OJ, Aprahamian CJ, Haricharan RN, Perger L, et al. Laparoscopic cholecystectomy for biliary dyskinesia in children: frequency increasing. J Pediatr Surg. 2013; 48:1716–1721. PMID: 23932611.

19. Chang YR, Jang JY, Kwon W, Park JW, Kang MJ, Ryu JK, et al. Changes in demographic features of gallstone disease: 30 years of surgically treated patients. Gut Liver. 2013; 7:719–724. PMID: 24312714.

20. Stender S, Nordestgaard BG, Tybjaerg-Hansen A. Elevated body mass index as a causal risk factor for symptomatic gallstone disease: a Mendelian randomization study. Hepatology. 2013; 58:2133–2141. PMID: 23775818.

21. Holcomb GW Jr, Holcomb GW 3rd. Cholelithiasis in infants, children, and adolescents. Pediatr Rev. 1990; 11:268–274. PMID: 2408028.

22. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006; 295:1549–1555. PMID: 16595758.

23. Luo J, Hu FB. Time trends of obesity in pre-school children in China from 1989 to 1997. Int J Obes Relat Metab Disord. 2002; 26:553–558. PMID: 12075583.

24. Bogue CO, Murphy AJ, Gerstle JT, Moineddin R, Daneman A. Risk factors, complications, and outcomes of gallstones in children: a single-center review. J Pediatr Gastroenterol Nutr. 2010; 50:303–308. PMID: 20118803.

25. Varadarajulu S, Wilcox CM, Hawes RH, Cotton PB. Technical outcomes and complications of ERCP in children. Gastrointest Endosc. 2004; 60:367–371. PMID: 15332025.

26. Metreweli C, So NM, Chu WC, Lam WW. Magnetic resonance cholangiography in children. Br J Radiol. 2004; 77:1059–1064. PMID: 15569653.

27. Langballe KO, Bardram L. Cholecystectomy in Danish children--a nationwide study. J Pediatr Surg. 2014; 49:626–630. PMID: 24726126.