Experience with
laparoscopic cholecystectomy for
biliary dyskinesia in children remains limited. The aim of this study was to examine the results of a single institution's experience with
laparoscopic cholecystectomy for the treatment
biliary dyskinesia in the pediatric population. Medical records were reviewed on all patients younger than age 18 who underwent
laparoscopic cholecystectomy at our institution from July 2004 to December 2006. Patients undergoing surgery for
biliary dyskinesia, as evidenced by a preoperative gallbladder ejection fraction of 40 per cent or less, comprised the study group. Of the 51 pediatric
laparoscopic cholecystectomies, 30 (58.8%) were performed for
biliary dyskinesia. The patients' ages ranged from 7 to 17 (mean, 12.67 years; SD, 2.75). Symptoms consisted of chronic right upper quadrant
pain (96.67%),
nausea/
vomiting (73.33%),
back pain (30.0%),
weight loss (13.33%), and a history of
pancreatitis (6.66%). The amount of time between onset of symptoms and surgery was as follows: 1 to 3 months (34.62%), 4 to 6 months (30.77%), 7 to 12 months (7.69%), and greater than 1 year (26.92%). Gallbladder ejection fraction ranged from 1 to 36 per cent (mean, 14.7%). Seven of the 30 (26.67%) underwent endoscopic evaluation as part of their preoperative workup (six upper endoscopy, one colonoscopy), all of which were noncontributory. Pathology revealed chronic
cholecystitis in 26 of 30 (93.3%), no abnormalities in three of 30 (10.0%), and unexpected
cholelithiasis in one of 30 (3.33%). No perioperative complications were encountered. Twenty-nine of the 30 patients were available for follow up and all but one reported relief of symptoms (96.55%). This study supports the use of
laparoscopic cholecystectomy as a safe and effective treatment for
biliary dyskinesia in the pediatric population. The success rate in our study was substantially higher than that reported in previous series. Routine preoperative endoscopy was not used and was reserved for investigation of ambiguous or unrelated complaints.