T. Wang1, D. W. Kays1, S. D. Larson1, J. A. Taylor1, S. Islam1 1University Of Florida,Surgery,Gainesville, FL, USA
Introduction: The number of pediatric patients undergoing cholecystectomy has increased over the past decade, including cholesterol and pigment stones. No clear data exists as to whether pediatric patients with cholesterol gallstones compared to pigment gallstones have different outcomes and should be managed differently. The purpose of this study is to report a cohort of patients with cholelithiasis due to cholesterol or hematologic disease and compare treatment and outcomes.
Methods: A retrospective review was performed on all pediatric cholecystectomies (defined as age 18 and younger) completed at a single institution between 2001 and 2014. Clinical data points including patient demographics, indication for operation, complications, and outcome were collected on all of the patients and analyzed. The cohort was separated into cholesterol, pigment stones, and biliary dyskinesia. Students t test and Fischer’s exact test were used as appropriate and a p value of less than 0.05 was considered significant.
Results:
Calculous disease accounted for 311 cases in the cohort of 382 patients. Of these a majority were cholesterol stones (68.9%). Patients with pigment stones were younger and more likely to be male gender compared to cholesterol. The table shows the differences between the groups. We found no difference in the use of ultrasound or HIDA as preoperative imaging, duration of symptoms, post operative ERCP, conversions to open procedure, or in the need for urgent procedure. Complication rates, including gallstone pancreatitis, were higher with cholesterol stones, despite comorbidities in the pigment group.
Conclusion: We noted significant differences between children undergoing cholecystectomy for cholesterol vs. pigment stones in presentation, preoperative procedures, complications, and symptom resolution. Pigment stone cases were less likely to have pain or nausea as symptoms and had higher percentage of symptom resolution after surgery. Prophylactic cholecystectomy for pigment stones may not be indicated based on this cohort. A prospective study would help to better understand these data.
