C. Dekonenko1, J. Sujka1, R. M. Dorman1, S. St. Peter1, T. Oyetunji1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Surgery,Kansas City, MO, USA
Introduction: Biliary dyskinesia (BD) is a common indication for cholecystectomy in children. Diagnosis is made by the presence of right upper quadrant abdominal pain, lack of gallstones on ultrasound, and a gallbladder ejection fraction (EF) that is abnormal. We previously reported resolution of symptoms at longterm post-operative follow-up in 61% of pediatric patients undergoing laparoscopic cholecystectomy for hypokinetic BD with EF of <35%; however, data supporting the efficacy of cholecystectomy for hyperkinetic BD (EF >75%) is sparse. We sought to determine whether children with hyperkinetic BD had similar resolution of their symptoms after laparoscopic cholecystectomy at our institution.
Methods: We conducted a retrospective chart review of children who had undergone laparoscopic cholecystectomy for hyperkinetic BD at our free-standing children’s hospital between September 2010 and July 2015. Patients were contacted via telephone and answered a short questionnaire regarding symptom resolution, whether they were happy to have undergone cholecystectomy, satisfaction with cholecystectomy on a 1-10 scale, and a narrative of additional workup or treatment for those with ongoing abdominal pain. Analysis of outcomes was performed only for patients who could be contacted. An unpaired t test was used to compare ejection fractions of patients with and without symptom resolution.
Results: Of the 13 patients identified on chart review, 8 participated in the phone survey. Median ejection fraction was 93% (range 81%- 99%) with a median follow-up of 3.75 (range 2.50-6.75) years. Five patients (one with ongoing pain and four with symptom resolution), were happy their gallbladder had been removed. Four patients (50%) reported symptom resolution. The median EF of the four patients with resolution of symptoms was 93.5% and the median EF of the four patients with ongoing pain was 91% (p = 0.24). Frequency of pain varied among the symptomatic patients, ranging from <1 time per week to a few times per day. Three of the patients rated their overall satisfaction with the results of surgery as 5.2 on a scale of 1-10. Two of the four symptomatic patients previously endorsed resolution of abdominal pain at their initial post-operative visit. Two patients reported seeing a physician other than their surgeon for their persistent symptoms and have undergone further diagnostic testing and procedures.
Conclusion: Some children with hyperkinetic biliary dyskinesia may benefit from cholecystectomy. However, a high ejection fraction does not correlate with symptom resolution.