Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Pediatric Cholecystectomy: Clinical Significance of Cases Unrelated to Hematologic Disorders

  • Kim, Hae-Young (Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine) ;
  • Kim, Soo-Hong (Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine) ;
  • Cho, Yong-Hoon (Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine)
  • Received : 2014.12.26
  • Accepted : 2015.03.30
  • Published : 2015.06.30
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Abstract

Purpose: Cholecystectomy is rarely performed in the child and adolescent. However, it is associated with several conditions. This study was conducted to describe the characteristics of pediatric patient who underwent cholecystectomy unrelated to hematologic disorders, and then to suggest its clinical significance in management by comparing a simple and complicated gallbladder disease. Methods: We reviewed cases of cholecystectomy in pediatric patients (under 18 years old) at a single institution between January 2003 and October 2014. There were 143 cases during the study period and 24 were selected as the subject group. Results: There were 7 male (29.2%) and 17 female (70.8%) patients. The mean age was 13.1 years old, and 66.6% of patients were older than 12 years. Mean body weight was 52.7 kg, and body mass index was $21.7kg/m^2$, with 41.7% of patients being overweight or obese. We could identify a female predominance and high proportion of overweight or obesity in a complicated disease. There were also significantly increased levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and bilirubin in this group. Most patients (87.5%) underwent laparoscopic cholecystectomy. Conclusion: Cholecystectomy for diseases unrelated to hematologic disorders is rarely performed in the child and adolescent. In general, female patients who are overweight or obese, and those older than 12 years old, require laparoscopic cholecystectomy owing to multiple gallstones. This condition has a tendency to show a complicated gallbladder disease and significantly increased levels of AST, ALT, ALP, and bilirubin.

Keywords

References

  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;158:585-8. https://doi.org/10.1016/0002-9610(89)90199-2
  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;17:561-9. https://doi.org/10.1046/j.1365-2036.2003.01439.x
  3. Kratzer W, Mason RA, Kachele V. Prevalence of gallstones in sonographic surveys worldwide. J Clin Ultrasound 1999;27:1-7. https://doi.org/10.1002/(SICI)1097-0096(199901)27:1<1::AID-JCU1>3.0.CO;2-H
  4. Balaguer EJ, Price MR, Burd RS. National trends in the utilization of cholecystectomy in children. J Surg Res 2006;134:68-73. https://doi.org/10.1016/j.jss.2006.02.053
  5. 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:e82-8. https://doi.org/10.1542/peds.2011-0579
  6. Waldhausen JH, Benjamin DR. Cholecystectomy is becoming an increasingly common operation in children. Am J Surg 1999;177:364-7. https://doi.org/10.1016/S0002-9610(99)00063-X
  7. Kaye AJ, Jatla M, Mattei P, Kelly J, Nance ML. Use of laparoscopic cholecystectomy for biliary dyskinesia in the child. J Pediatr Surg 2008;43:1057-9. https://doi.org/10.1016/j.jpedsurg.2008.02.034
  8. 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;74:1069-72.
  9. Al-Homaidhi HS, Sukerek H, Klein M, Tolia V. Biliary dyskinesia in children. Pediatr Surg Int 2002;18:357-60. https://doi.org/10.1007/s00383-002-0822-3
  10. Whitington PF, Black DD. Cholelithiasis in premature infants treated with parenteral nutrition and furosemide. J Pediatr 1980;97:647-9. https://doi.org/10.1016/S0022-3476(80)80033-3
  11. Roslyn JJ, Berquist WE, Pitt HA, Mann LL, Kangarloo H, DenBesten L, et al. Increased risk of gallstones in children receiving total parenteral nutrition. Pediatrics 1983;71:784-9.
  12. Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 2005;7:132-40. https://doi.org/10.1007/s11894-005-0051-8
  13. Skelton JA, Cook SR, Auinger P, Klein JD, Barlow SE. Prevalence and trends of severe obesity among US children and adolescents. Acad Pediatr 2009;9:322-9. https://doi.org/10.1016/j.acap.2009.04.005
  14. Al-Salem AH, Qaisruddin S. The significance of biliary sludge in children with sickle cell disease. Pediatr Surg Int 1998;13:14-6. https://doi.org/10.1007/s003830050233
  15. 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;31:411-7. https://doi.org/10.1097/00005176-200010000-00015
  16. 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;84:1378-82.
  17. 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. https://doi.org/10.1093/oxfordjournals.aje.a115007
  18. Angelico F, Del Ben M, Barbato A, Conti R, Urbinati G. Ten-year incidence and natural history of gallstone disease in a rural population of women in central Italy. The Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). Ital J Gastroenterol Hepatol 1997;29:249-54.
  19. Zubler J, Markowski G, Yale S, Graham R, Rosenthal TC. Natural history of asymptomatic gallstones in family practice office practices. Arch Fam Med 1998;7:230-3. https://doi.org/10.1001/archfami.7.3.230
  20. Attili AF, De Santis A, Capri R, Repice AM, Maselli S. The natural history of gallstones: the GREPCO experience. The GREPCO Group. Hepatology 1995;21:655-60.
  21. Friedman GD, Raviola CA, Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol 1989;42:127-36. https://doi.org/10.1016/0895-4356(89)90086-3
  22. McSherry CK, Ferstenberg H, Calhoun WF, Lahman E, Virshup M. The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg 1985;202:59-63.
  23. Miltenburg DM, Schaffer R 3rd, Breslin T, Brandt ML. Changing indications for pediatric cholecystectomy. Pediatrics 2000;105:1250-3. https://doi.org/10.1542/peds.105.6.1250
  24. Kumar R, Nguyen K, Shun A. Gallstones and common bile duct calculi in infancy and childhood. Aust N Z J Surg 2000;70:188-91. https://doi.org/10.1046/j.1440-1622.2000.01783.x
  25. Schweizer P, Lenz MP, Kirschner HJ. Pathogenesis and symptomatology of cholelithiasis in childhood. A prospective study. Dig Surg 2000;17:459-67. https://doi.org/10.1159/000051941
  26. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 1999;117:632-9. https://doi.org/10.1016/S0016-5085(99)70456-7
  27. Henschke CI, Teele RL. Cholelithiasis in children: recent observations. J Ultrasound Med 1983;2:481-4. https://doi.org/10.7863/jum.1983.2.11.481
  28. Reif S, Sloven DG, Lebenthal E. Gallstones in children. Characterization by age, etiology, and outcome. Am J Dis Child 1991;145:105-8. https://doi.org/10.1001/archpedi.1991.02160010111028
  29. 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;50:303-8. https://doi.org/10.1097/MPG.0b013e3181b99c72
  30. Khoo AK, Cartwright R, Berry S, Davenport M. Cholecystectomy in English children: evidence of an epidemic (1997-2012). J Pediatr Surg 2014;49:284-8. https://doi.org/10.1016/j.jpedsurg.2013.11.053
  31. Holcomb GW Jr, Holcomb GW 3rd. Cholelithiasis in infants, children, and adolescents. Pediatr Rev 1990;11:268-74. https://doi.org/10.1542/pir.11-9-268
  32. 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;295:1549-55. https://doi.org/10.1001/jama.295.13.1549
  33. 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;26:553-8. https://doi.org/10.1038/sj.ijo.0801944
  34. Varadarajulu S, Wilcox CM, Hawes RH, Cotton PB. Technical outcomes and complications of ERCP in children. Gastrointest Endosc 2004;60:367-71. https://doi.org/10.1016/S0016-5107(04)01721-3
  35. Metreweli C, So NM, Chu WC, Lam WW. Magnetic resonance cholangiography in children. Br J Radiol 2004;77:1059-64. https://doi.org/10.1259/bjr/34655158

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