Laparoscopic Cholecystectomy for Biliary Dyskinesia in Children: Report of 100 Cases from a Single Institution

2008 ◽  
Vol 74 (7) ◽  
pp. 587-593 ◽  
Author(s):  
Constantinos Constantinou ◽  
Iswanto Sucandy ◽  
Max Ramenofsky
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Ejection Fraction ◽  
Primary Care Physicians ◽  
Pediatric Population ◽  
Biliary Dyskinesia ◽  
Successful Outcome ◽  
Symptom Duration ◽  
Functional Abdominal Pain ◽  
Biliary Stones ◽  
Persistent Symptoms

Laparoscopic cholecystectomy (LC) is increasingly performed in the pediatric population. Biliary dyskinesia (BD) is largely responsible for this increase and is presently the most common indication for LC in this age group. In our institution the diagnosis of BD is made in patients with biliary symptoms, absence of biliary stones, and an ejection fraction <35 per cent on hydroxy iminoadiacetic acid (HIDA) scan. We reviewed our experience of 100 children with BD that underwent LC. Data that was prospectively collected and entered into electronic medical records by gastroenterologists, primary care physicians, and pediatric surgeons was reviewed and analyzed. Patients were symptomatic for an average of 15 months before undergoing surgery. Seventy-seven per cent reported resolution of symptoms from 6 months to 5 years following LC, whereas the rest complained of persistent symptomatology. When the two groups were compared, patients with persistent symptoms were more likely to be female and to have longer symptom duration. An ejection fraction <35 per cent reliably predicts successful outcome of LC in patients with BD. The diagnosis of BD should be entertained early in the differential of functional abdominal pain in children and referred to Pediatric Surgery when its presence is confirmed.

Laparoscopic Cholecystectomy for Treatment of Biliary Dyskinesia is Safe and Effective in the Pediatric Population

2008 ◽  
Vol 74 (11) ◽  
pp. 1069-1072 ◽  
Author(s):  
Matthew Hofeldt ◽  
Bryan Richmond ◽  
Kristy Huffman ◽  
Jennings Nestor ◽  
Damian Maxwell
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Ejection Fraction ◽  
Perioperative Complications ◽  
Pediatric Population ◽  
Biliary Dyskinesia ◽  
Quadrant Pain ◽  
Gallbladder Ejection Fraction ◽  
Patients Âgés ◽  
History Of

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.

Quality of Life after Laparoscopic Cholecystectomy for Biliary Dyskinesia in the Pediatric Population: A Pilot Study

2012 ◽  
Vol 78 (1) ◽  
pp. 111-118 ◽  
Author(s):  
Damian Maxwell ◽  
Stephanie Thompson ◽  
Bryan Richmond ◽  
Jillian McCagg ◽  
Adam Ubert
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Cholecystectomy ◽  
Pilot Study ◽  
Pediatric Population ◽  
Symptom Relief ◽  
Well Being ◽  
Biliary Dyskinesia ◽  
Gallbladder Ejection Fraction

This pilot study examined symptom relief and quality of life in pediatric patients who received laparoscopic cholecystectomy surgery at our institution for biliary dyskinesia. We used two validated questionnaires: the Child Health Questionnaire (CHQ-PF28), to assess general well-being, and the Gastrointestinal Quality of Life Index (GIQLI), to measure gastrointestinal-related health. After Institutional Review Board approval, all patients under the age of 18 years who underwent laparoscopic cholecystectomy for biliary dyskinesia between November 2006 and May 2010 received mailed questionnaires. Preoperative and postoperative data were retrospectively collected from respondents and included age, race, symptoms, gallbladder ejection fraction values, pathologic findings, and clinical course. Of 89 patients meeting inclusion criteria, 21 responded. Mean age at surgery was 13.08 years (range, 8 to 17 years). The most common preoperative symptoms consisted of nausea (100%), postprandial pain (90.5%), right upper quadrant pain (81.0%), and vomiting (66.7%). Mean long-term follow-up interval was 18.9 months (range, 7 to 40 months; SD 10.37). Patients with long-term symptom relief reported significantly higher GIQLI scores than those with enduring symptoms. Examination of the results from the CHQ-PF28 revealed significantly lower scores than a general U.S. pediatric sample in both the Physical and Psychosocial Summary Measures ( P < 0.05). Children experiencing long-term symptom cessation after laparoscopic cholecystectomy reported higher quality of life than those who had incomplete or only short-term relief. However, regardless of the degree of symptom relief, the degree of quality of life experienced by our study sample of patients with biliary dyskinesia is lower than that of a comparable U.S. pediatric sample.

Pediatric Biliary Dyskinesia: Evaluating Predictive Factors for Successful Treatment of Biliary Dyskinesia with Laparoscopic Cholecystectomy

2018 ◽  
Vol 84 (9) ◽  
pp. 1401-1405
Author(s):  
Yamuna T. Krishna ◽  
Kristine L. Griffin ◽  
Robert L. Gates
Keyword(s):  
Ejection Fraction ◽  
Pediatric Patients ◽  
Epigastric Pain ◽  
Iminodiacetic Acid ◽  
Biliary Dyskinesia ◽  
Study Patient ◽  
Duration Of Symptoms ◽  
Symptom Resolution ◽  
Persistent Symptoms ◽  
Postoperative Symptom

Biliary dyskinesia (BD) is a motility disorder of the gallbladder that can result in right upper quadrant (RUQ) pain, nausea, vomiting, and diarrhea. Cholecystectomy is considered the standard of care for BD. Up to 23 per cent of pediatric patients who undergo surgery for BD have persistent symptoms postoperatively. We performed a retrospective review to identify preoperative factors significantly associated with symptom resolution after cholecystectomy. We retrospectively reviewed pediatric patients aged 10–17 years diagnosed with BD who underwent cholecystectomy between 2006 and 2016. Patients were divided into two groups based on postoperative symptom resolution. Chi-squared and student t tests were used to compare patient groups. Two hundred and thirty-six patients were included in the study. The most common preoperative symptoms included RUQ pain (80.1%), nausea (54.2%), postprandial pain (44.5%), vomiting (32.6%), and epigastric pain (19.9%). The rate of postoperative symptom resolution was 68.6 per cent. Comparative analysis showed patients who presented with RUQ pain, nausea, postprandial pain, or constipation experienced significantly higher rates of symptom resolution postoperatively. In addition, patients with ejection fraction <35 per cent or pain reproducible with cholecystokinin were found to have significantly higher rates of symptom resolution as well. To date, it remains difficult to predict successful outcomes for pediatric patients undergoing cholecystectomy for BD. In our study, patient demographics and duration of symptoms did not affect postoperative outcomes. Pediatric patients who presented with RUQ pain, nausea, postprandial pain, constipation, an ejection fraction of <35 per cent on hepatobiliary iminodiacetic acid, or pain reproducible with cholecystokinin injection, were found to have significantly higher rates of symptom resolution.

Outcomes After Laparoscopic Cholecystectomy in Hyperkinetic Biliary Dyskinesia

2021 ◽  
pp. 000313482110233
Author(s):  
Litton F. Whitaker ◽  
Maggie E. Bosley ◽  
Justin M. Refugia ◽  
Myron S. Powell ◽  
Stephen S. McNatt ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Epigastric Pain ◽  
Care Center ◽  
Tertiary Care ◽  
Biliary Dyskinesia ◽  
Inclusion Criteria ◽  
Biliary Stones ◽  
Gallbladder Ejection Fraction ◽  
Symptom Status

Background Biliary dyskinesia (BD) is a poorly understood functional gallbladder disorder. Diagnosis is made with abdominal pain and an intact gallbladder without signs of anatomical obstruction on imaging or pathology. Our aim was to assess whether laparoscopic cholecystectomy (LC) resolves hyperkinetic BD symptoms. Methods Records of patients ≥18 years of age, who underwent LC by four surgeons at a tertiary care center between 2012 and 2020, were retrospectively reviewed. Patients were excluded if they had a documented gallbladder ejection fraction (GBEF) <80% or had biliary stones or sludge on pathology or imaging. Demographic information, HIDA results, preoperative testing, operative details, gallbladder pathology, and symptom status at follow-up were collected from electronic medical records. Improvement in BD symptoms was assessed using McNemar’s test. Risk differences with standard errors were employed to estimate percent reduction in symptoms. Results Ninety-eight patients met inclusion criteria. Of those who presented for follow-up (n = 91), 92.3% (n = 84) reported partial or complete resolution of symptoms. Preoperative symptoms, including back pain (16.7%, 95% CI: [7.9%, 25.5%]; P < .0001), epigastric pain (31.1% [21.3%, 41.3%]; P < .0001), nausea (56.7% [45.0%, 65.8%]; P < .0001), RUQ pain (57.8% [46.1%, 66.9%]; P < .0001), and vomiting (27.8% [18.4%, 37.7%]; P < .0001) showed significant improvement after LC. Chronic cholecystitis and/or cholesterolosis were present on pathology in 79.8% of gallbladders. Discussion Our study currently represents the largest cohort of patients with hyperkinetic BD. Laparoscopic cholecystectomy appears to result in resolution of symptoms for this clinical entity.

Abnormal gallbladder nuclear ejection fraction predicts success of cholecystectomy in patients with biliary dyskinesia

1993 ◽  
Vol 166 (6) ◽  
pp. 672-675 ◽  
Author(s):  
Marney K. Sorenson ◽  
Sara Fancher ◽  
Nicholas P. Lang ◽  
John F. Edit ◽  
J. Ralph Broadwater
Keyword(s):  
Ejection Fraction ◽  
Biliary Dyskinesia

High frequency of otolaryngology/ENT encounters in Canadian primary care despite low medical undergraduate

2021 ◽  
Author(s):  
Brendan Sorichetti ◽  
Julie Pauwels ◽  
Thomas Jacobs ◽  
Neil Chadha ◽  
Emelie Kozak ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Primary Care Physicians ◽  
Pediatric Population ◽  
Adult Population ◽  
Care Facility ◽  
Symptom Presentation ◽  
Undergraduate Medical Students ◽  
Related Symptom ◽  
Medical Undergraduate

Otolaryngology involves the treatment of patients with diseases and disorders of the ear, nose, throat (ENT), and related structures of the head and neck. Many medical students in Canada have limited experiences in ENT and a vast majority of these students go on to pursue a career as primary care physicians. Physicians at a primary care facility classified patient’s visits as either being “ENT” related or not, to assess the amount of ENT related concerns they typically encounter. The data was collected separately in the summer and winter months to assess any seasonal variability. One in eight patient encounters presented with an ENT related concern. The percentage of ENT related symptom presentation visits in the pediatric population for both data collection periods (29%) was more than three times that of the adult population (9%). The rate of ENT symptom presentation in both adult and pediatric populations was not affected by seasonality. Primary care physicians will encounter new patients presenting with ENT related concerns quite frequently. This is especially true in the pediatric patient population. Increased ENT medical education is both necessary and essential for undergraduate medical students, residents, and primary care physicians.

scholarly journals Determinants for Predicting the Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy - A Prospective Study

2020 ◽  
Vol 7 (50) ◽  
pp. 3006-3009
Author(s):  
Sandeep Kumar Goyal ◽  
Gopal Singhal ◽  
Bhanu Pratap Sharma ◽  
Dinesh Mohan ◽  
Savita Savita ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Scoring System ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
Age Groups ◽  
Successful Outcome ◽  
Difficulty Level ◽  
Scoring Method ◽  
Conversion Rates ◽  
Group 3

BACKGROUND Laparoscopic surgery is a kind of minimal access surgery that obviates various complications which are encountered during open method, but the outcome of procedure varies according to condition of the patient. Knowledge of these factors may be used for the preoperative counselling of the patients regarding the successful outcome of the surgery as well as to herald the risk of conversion before undertaking patients. We wanted to evaluate the various preoperative factors for conversion of laparoscopic cholecystectomy to open cholecystectomy.c METHODS A total of 100 patients of both sexes, from all age groups and socio-economic status was included in the study. All routine investigations and USG (Ultrasonography) were done. Risk factors assessed were age, sex, abdominal tenderness, gall bladder wall thickness, any history of para-umbilical surgery. Clinical evaluation was done for each included patient and score was given according to their signs and symptoms. Patients were categorised subsequently into mild (group 1 & 2), moderate (group 3 & 4) and severe (group 5) difficulty as per scoring method. RESULTS The mean age was 46.21 ± 13.36, ranging between 20 years to 80 years (95 % CI 43.56 to 48.86) with 89 females and 11 males. Among the converted group, 3 (18.75 %) participants were > 60 years of age and 2 (2.38 %) participants were of age < 60 years. According to patient's expected level of difficulty in laparoscopic cholecystectomy and according to scoring system, patients were categorised as mild, moderate and severe. A total of 81 patients were categorised as mild, 17 as moderate and 2 as severe. Conversion rate is 0 % in mild difficulty group, 17.64 % in moderate difficulty group and 100 % in severe difficulty group. CONCLUSIONS Difficulty and conversion risk may be predicted accurately by using the scoring system. Surging scores indicated marked increase in difficulty levels intraoperatively and thus affects the conversion rates. Thus, it can be concluded that the scoring system accurately assessed the conversion rates of laparoscopic cholecystectomy preoperatively to open surgery. Higher scores indicated increase in difficulty level. KEYWORDS Laparoscopic Cholecystectomy, Open Cholecystectomy, Determinants

Sign in / Sign up

Export Citation Format

Share Document