Predictors of successful outcome after cholecystectomy for biliary dyskinesia.
OBJECTIVE
Laparoscopic cholecystectomy is accepted therapy for children with ill-defined abdominal pain and impaired gallbladder emptying (biliary dyskinesia). Follow-up shows poor clinical response in many of these patients. The purpose of this report is to identify clinical and radiographic predictors of successful outcome after cholecystectomy for biliary dyskinesia.


METHODS
The authors retrospectively reviewed records of 51 children after laparoscopic cholecystectomy for biliary dyskinesia (1990 to 2003). Clinical symptoms, radiographic findings, and pathology were evaluated. Subjective clinical improvement is stratified using an established patient satisfaction score. Logistic regression analysis determines statistically independent predictors of successful outcome.


RESULTS
Thirty-eight of 51 (75%) patients were available for follow-up. Twenty-seven of 38 (71%) patients reported complete resolution of symptoms. Nausea was the only symptom predictive of successful outcome by univariate analysis (odds ratio, 5.00). A cholecystokinin-stimulated, gallbladder ejection fraction less than 15% also predicts successful outcome (odds ratio, 8.00). Children with an ejection fraction greater than 15% did not have predictable resolution of symptoms. When present with pain and nausea, gallbladder emptying less than 15% has a positive predictive value of 93% and a negative predictive value of 81%.


CONCLUSIONS
Together, nausea, pain, and decreased gallbladder emptying (<15%) most reliably predict which children will benefit from cholecystectomy for biliary dyskinesia.
Carney
David E
DE
Section of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine and the J.W. Riley Hospital for Children, Indianapolis, IN 46202, USA.
Kokoska
Evan R
ER
Grosfeld
Jay L
JL
Engum
Scott A
SA
Rouse
Thomas M
TM
West
Karen M
KM
Ladd
Alan
A
Rescorla
Frederick J
FJ
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D001657:Biliary Dyskinesia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D002766:Cholecystokinin / Q000494:pharmacology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D016473:Gallbladder Emptying / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009325:Nausea / Q000209:etiology; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
D002766:Cholecystokinin