Y. Puckett1, K. Chatoorgoon1, C. Fitzpatrick1, D. Vane1, J. Greenspon1 1Saint Louis University School Of Medicine,Pediatric Surgery,St. Louis, MO, USA
Introduction: Reports from other pediatric centers have defined obesity and Hispanic ethnicity as important risk factors for symptomatic cholelithiasis in children. We aimed to determine if other risk factors exist and if obesity and ethnicity are true risk factors versus symptoms of a more global etiology.
Methods: A retrospective review was performed on all children 0 to 19 years old who underwent a cholecystectomy from 1993-2014 in St. Louis, Missouri. Data was divided into 2 cohorts: Group I (1993-2003) and Group II (2004-2014). Age, gender, body mass index (BMI), weight group, race, ethnicity, indication for cholecystectomy, and type of gallstones were collected. Data was analyzed using Pearson’s-chi square test and and Fisher’s exact test for categorical variables and the Mann-Whitney U test for continuous variables.
Results: 452 patients underwent a cholecystectomy from 1993 to 2014. There were 171 patients in Group I and 281 patients in Group II. The rate of hemolytic disease requiring cholecystectomy was essentially unchanged (G1=70, G2=67) (p<.0001). Biliary dyskinesia was an indication only in the second group (G1=0,G2=28) (p<.0001). Cholecystectomy for non-hemolytic gallstones increased 82% (101-184) (p<.0001). Incidence of cholecystectomy remained stable in underweight children (G1=20, G2=21) (p<.003) however incidence of cholecystectomy in normal (G1=35, G2=53), overweight (G1=9, G2=24), obese (G1=23, G2=58) and severely overweight (G1=14, G2=28) children increased dramatically (p<.003). Mean BMI for the two groups increased slightly, (G1=23, G2=27.5) (p<.002), but essentially remained within the normal range.
Conclusion: At our institution, children undergoing cholecystectomy were found to have a normal BMI overall. However, the prevalence of overweight children undergoing cholecystectomies increased dramatically. In spite of significant increases in obesity in this population, the overall normal BMI of both groups suggests that diet rather than obesity may be the most significant etiology in the increased incidence of cholelithiasis in this pediatric population.