F. O. Badru1, Y. Puckett1, R. Breeden1, M. Bourdillon1, C. Fitzpatrick1, K. Chatoorgoon1, J. Greenspon1, D. Vane1, G. Villalona1 1St. Louis University,Pediatric Surgery,St. Louis, MO, USA
Introduction: Little data exists regarding the recurrence of pancreatitis in pediatric patients with gallstone pancreatitis awaiting cholecystectomy. It is also unclear whether factors such as preoperative common bile duct (CBD) size and endoscopic retrograde cholangiopancreatography (ERCP) with stent placement reduce the risk of recurrence. This study evaluates the recurrence rate of pancreatitis after acute gallstone pancreatitis based on the timing of cholecystectomy in pediatric patients. We hypothesized that there is an increased recurrence of pancreatitis when cholecystectomy is not performed during the index admission.
Methods: A retrospective chart review of all consecutive patients admitted with gallstone pancreatitis to a large pediatric center from 2007 to 2015 was performed. Children were divided into five groups depending on the timing of cholecystectomy. Group 1 had surgery during the index admission, group 2 had surgery within 2 weeks of discharge, group 3 had surgery between 2 to 6 weeks post discharge, group 4 had surgery 6 weeks after discharge and group 5 patients had no surgery. Demographic data including type of surgical procedure, age, sex, and race were obtained. The recurrence rates of pancreatitis were calculated for all groups.
Results: A total of 195 patients were treated for pancreatitis in the 8 year period, of which 48 (24.6%) had gallstone pancreatitis. There were 11 (22.9%) males and 37 (77.1%) females, with a median age of 14.4 years (range 1.7 – 17.8 years). Median BMI was 25.8 (15.1 – 48.3). Cholecystectomy was performed in 19 of 48 patients (39.6%) during the index admission, with no recurrence of pancreatitis. Of the remaining 29 patients, nine (31%) had recurrence of pancreatitis or required readmission for abdominal pain prior to cholecystectomy. There recurrence rates were 2/8 in group 2 (25%), 3/8 (37.5%) in group 3, 3/5 (60%) in group 4, and 1/8 (12.5%) in group 5. No children in group 5 had demonstrable gallstones at presentation, but only sludge in their gallbladder. Total mean hospital days for patients in group 1 was 4 days while total mean hospital days for patients in groups 2-4 was 6 days. This resulted in a potential health care dollar savings of $3,664 per patient if cholecystectomy was performed at index admission, without additional patient complications.
Conclusion: Cholecystectomy during the index admission is associated with no recurrence or readmission for pancreatitis. If cholecystectomy is delayed, the rate of recurrent pancreatitis is proportionally increased with time from index admission. Therefore we recommend that cholecystectomy be performed after resolution of an episode of gallstone pancreatitis during index admission. This clinical pathway is not associated with increased surgical complications or bile duct injuries and results in a potential savings of $72,744 for this small group of patients if surgery during the index admission is performed.