دورية أكاديمية
A pediatric surgeon's dilemma: does cholecystectomy improve symptoms of biliary dyskinesia?
| العنوان: | A pediatric surgeon's dilemma: does cholecystectomy improve symptoms of biliary dyskinesia? |
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| المؤلفون: | Liebe HL; Ochsner Clinic Foundation, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA. heather.liebe@gmail.com., Phillips R; Ochsner Clinic Foundation, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA., Handley M; Ochsner Clinic Foundation, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA., Gastanaduy M; Division of Academics, Ochsner Health, Ochsner Center for Outcomes and Health Services Research, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA., Burton JH; Division of Academics, Ochsner Health, Ochsner Center for Outcomes and Health Services Research, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA., Roybal J; Ochsner Clinic Foundation, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA. |
| المصدر: | Pediatric surgery international [Pediatr Surg Int] 2021 Sep; Vol. 37 (9), pp. 1251-1257. Date of Electronic Publication: 2021 May 11. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Springer International Country of Publication: Germany NLM ID: 8609169 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1437-9813 (Electronic) Linking ISSN: 01790358 NLM ISO Abbreviation: Pediatr Surg Int Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Berlin : Springer International, c1986- |
| مواضيع طبية MeSH: | Biliary Dyskinesia*/complications , Biliary Dyskinesia*/surgery , Cholecystectomy, Laparoscopic* , Surgeons*, Adolescent ; Adult ; Child ; Cholecystectomy ; Female ; Humans ; Retrospective Studies ; Treatment Outcome |
| مستخلص: | Background: Biliary dyskinesia (BD) is a well-established gallbladder pathology in adult patients and rates of cholecystectomy for BD continue to rise in the United States. Many pediatric patients with vague abdominal pain of variable duration are evaluated for biliary dyskinesia. It remains unknown which cohort of pediatric patients diagnosed with BD are most likely to have sustained improvement in symptoms following laparoscopic cholecystectomy. We aimed to determine whether cholecystectomy resulted in symptom relief and led to a reduction in the number of medical visits related to gastrointestinal (GI) symptoms after surgery. Methods: We performed a multi-institution retrospective review of all children < 18 years of age who underwent laparoscopic cholecystectomy for BD between January 2013 and April 2018 in our hospital system. GI symptoms and clinical visits related to a GI complaint were assessed preoperatively. Patients were followed for 2 years after surgery. At 6 months and 2 years postoperatively, symptoms and the rate of medical visits related to a GI complaint were quantified and compared to the preoperative values. Results: In total, 45 patients met our inclusion criteria. Of these, 82% of patients were female. The average age was 14 years old (± 2.6) and 56% of patients met the criteria for being overweight or obese. The mean gallbladder ejection fraction was 13% (± 10.8). All patients had abdominal pain, 82% (37/45) presented with nausea, and 51% (23/45) presented with post-prandial pain. Six months postoperatively, 58% of patients experienced resolution of their abdominal pain which decreased to 38% of patients after 2 years. Similarly, 59% had resolution of their nausea at 6 months compared to 43% at 2 years, and 100% had resolution of their post-prandial pain at 6 months compared to 91% at 2 years. The total number of clinical visits related to a GI complaint decreased from 2.6 (± 2.4) preoperatively to 1.0 (± 1.3) within 6 months postoperatively. When followed to 2 years postoperatively, the 6-month rate of clinical visits related to a GI complaint decreased from a mean of 2.6 preoperatively to 0.71 following surgery. Conclusions: Following cholecystectomy, we observed a high percentage of durable symptom resolution in those patients with BD who presented with post-prandial pain. Patients with non-food-related abdominal pain, with or without nausea and vomiting, had a lower rate of symptom resolution after surgery and the rate declined with time. For patients without post-prandial pain, evaluation and treatment of alternative sources of pain should be considered prior to surgery. Regardless of their presenting symptoms, patients who underwent surgery for BD had fewer clinical GI-related visits after surgery. However, no specific gallbladder ejection fraction or symptom alone was predictive of a lower rate of clinical visits postoperatively. (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.) |
| References: | Santucci NR, Hyman PE, Harmon CM, Schiavo JH, Hussain SZ (2017) Biliary dyskinesia in children: a systematic review. J Pediatr Gastroenterol Nutr 64(2):186–193. https://doi.org/10.1097/mpg.0000000000001357. (PMID: 10.1097/mpg.000000000000135727472474) Lacher M, Yannam GR, Muensterer OJ, Aprahamian CJ, Haricharan RN, Perger L, Harmon CM et al (2013) Laparoscopic cholecystectomy for biliary dyskinesia in children: frequency increasing. J Pediatr Surg 48(8):1716–1721. https://doi.org/10.1016/j.jpedsurg.2012.08.036. (PMID: 10.1016/j.jpedsurg.2012.08.03623932611) Carney DE, Kokoska ER, Grosfeld JL, Engum SA, Rouse TM, West KM, Rescorla FJ et al (2004) Predictors of successful outcome after cholecystectomy for biliary dyskinesia. J Pediatr Surg 39(6):813–816. https://doi.org/10.1016/j.jpedsurg.2004.02.017. (PMID: 10.1016/j.jpedsurg.2004.02.01715185202) Clark CJ (2019) An update on biliary dyskinesia. Surg Clin North Am 99(2):203–214. https://doi.org/10.1016/j.suc.2018.11.004. (PMID: 10.1016/j.suc.2018.11.00430846030) Cotton PB, Elta GH, Carter CR, Pasricha PJ, Corazziari ES (2016) Gallbladder and sphincter of Oddi disorders. Gastroenterology 150(6):1420. https://doi.org/10.1053/j.gastro.2016.02.033. (PMID: 10.1053/j.gastro.2016.02.033) Adams DB (2013) Biliary dyskinesia: does it exist? If so, how do we diagnose it? Is laparoscopic cholecystectomy effective or a sham operation? J Gastrointest Surg 17(9):1550–1552. https://doi.org/10.1007/s11605-013-2267-5. (PMID: 10.1007/s11605-013-2267-523818126) Cairo SB, Aranda A, Bartz-Kurycki M, Baxter KJ, Bonasso P, Dassinger M, Rothstein DH et al (2019) Variability in perioperative evaluation and resource utilization in pediatric patients with suspected biliary dyskinesia: a multi-institutional retrospective cohort study. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2019.02.049. (PMID: 10.1016/j.jpedsurg.2019.02.049311097316822378) Cairo SB, Ventro G, Sandoval E, Rothstein DH (2018) Long-term results of cholecystectomy for biliary dyskinesia: outcomes and resource utilization. J Surg Res 230:40–46. https://doi.org/10.1016/j.jss.2018.04.044. (PMID: 10.1016/j.jss.2018.04.04430100038) Haricharan RN, Proklova LV, Aprahamian CJ, Morgan TL, Harmon CM, Barnhart DC, Saeed SA (2008) Laparoscopic cholecystectomy for biliary dyskinesia in children provides durable symptom relief. J Pediatr Surg 43(6):1060–1064. https://doi.org/10.1016/j.jpedsurg.2008.02.032. (PMID: 10.1016/j.jpedsurg.2008.02.03218558183) Knott EM, Fike FB, Gasior AC, Cusick R, Brownie E, Peter SD, Azarow KS (2013) Multi-institutional analysis of long-term symptom resolution after cholecystectomy for biliary dyskinesia in children. Pediatr Surg Int 29(12):1243–1247. https://doi.org/10.1007/s00383-013-3343-3. (PMID: 10.1007/s00383-013-3343-323846453) Lai SW, Rothenberg SS, Kay SM, Shipman KE, Slater BJ (2017) Outcomes of laparoscopic cholecystectomy for biliary dyskinesia in children. J Laparoendosc Adv Surg Tech 27(8):845–850. https://doi.org/10.1089/lap.2016.0338. (PMID: 10.1089/lap.2016.0338) Lyons H, Hagglund KH, Smadi Y (2011) Outcomes after laparoscopic cholecystectomy in children with biliary dyskinesia. Surg Laparosc Endosc Percutan Tech 21(3):175–178. https://doi.org/10.1097/sle.0b013e31821db7b2. (PMID: 10.1097/sle.0b013e31821db7b221654301) Mahida JB, Cooper JN, Deans KJ, Minneci PC (2015) Prediction of symptom improvement in children with biliary dyskinesia. J Surg Res 198:393–399. (PMID: 10.1016/j.jss.2015.03.056) Wybourn CA, Kitsis RM, Baker TA, Degner B, Sarker S, Luchette FA (2013) Laparoscopic cholecystectomy for biliary dyskinesia: which patients have long term benefit? Surgery 154(4):761–768. https://doi.org/10.1016/j.surg.2013.04.044. (PMID: 10.1016/j.surg.2013.04.04424074413) Misra S (2011) Is biliary scintigraphy a reliable diagnostic tool for biliary dyskinesia in children? J Clin Gastroenterol 45(9):814–817. https://doi.org/10.1097/mcg.0b013e31820fecff. (PMID: 10.1097/mcg.0b013e31820fecff21921844) Robin SG, Keller C, Zwiener R, Hyman PE, Nurko S, Saps M, Tilburg MA et al (2018) Prevalence of pediatric functional gastrointestinal disorders utilizing the Rome IV criteria. J Pediatr 195:134–139. https://doi.org/10.1016/j.jpeds.2017.12.012. (PMID: 10.1016/j.jpeds.2017.12.01229398057) Ghandour RM, Sherman LJ, Vladutiu CJ, Ali MM, Lynch SE, Bitsko RH, Blumberg SJ (2019) Prevalence and treatment of depression, anxiety, and conduct problems in US children. J Pediatr 206:256-267.e3. https://doi.org/10.1016/j.jpeds.2018.09.021. (PMID: 10.1016/j.jpeds.2018.09.02130322701) Data and Statistics on Children's Mental Health | CDC (n.d.) Retrieved from https://www.cdc.gov/childrensmentalhealth/data.html. Srinath AI, Youk A, Bielefeldt K (2014) Biliary dyskinesia and symptomatic gallstone disease in children: two sides of the same coin? Gastroenterology 146(5):1307–1315. https://doi.org/10.1016/s0016-5085(14)61505-5. (PMID: 10.1016/s0016-5085(14)61505-5) |
| فهرسة مساهمة: | Keywords: Biliary colic; Biliary dyskinesia; Cholecystectomy; Gallbladder; Laparoscopic cholecystectomy; Pediatric |
| تواريخ الأحداث: | Date Created: 20210512 Date Completed: 20210927 Latest Revision: 20210927 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1007/s00383-021-04922-1 |
| PMID: | 33977350 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1437-9813 |
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| DOI: | 10.1007/s00383-021-04922-1 |