title: Outcomes of Laparoscopic Cholecystectomy for Biliary Dyskinesia in Children.
abstract: OBJECTIVE
  To determine the outcomes of laparoscopic cholecystectomy as a treatment for biliary dyskinesia in children.
  
  
  METHODS
  With ethics approval, a retrospective chart review was performed on children (<21 years) at a single center diagnosed with biliary dyskinesia (defined as gallbladder ejection fraction [EF] <35% and/or pain with cholecystokinin [CCK] on cholescintigraphy, in the absence of gallstones or cholecystitis on ultrasound) and treated with laparoscopic cholecystectomy between March 2010 and February 2016. Demographic, medical history, diagnostic imaging, pathology, and outcome data were collected and analyzed based on degree of symptom resolution.
  
  
  RESULTS
  Laparoscopic cholecystectomy was performed in 215 children with biliary dyskinesia (156/215 [72.6%] female, age 13.8 ± 3.4 years, body mass index [BMI] 22.3 ± 6.3 kg/m2). 181/206 (87.9%) had EF <35%. CCK reproduced symptoms in 149/177 (84.2%). 34/215 (15.8%) were lost to follow-up. Median follow-up time was 2.7 weeks. Pain improved in 162/181 (89.5%). Chronic cholecystitis was found in 183/213 (85.9%) and unexpected cholelithiasis in 4/213 (1.9%) on pathology. Postoperatively, 6/181 (3.3%) had wound infections and 8/181 (4.4%) required common bile duct stents for the following indications: 6 sphincter of Oddi dysfunction, 1 choledocholithiasis, and 1 stricture. Virgin abdomen (odds ratio [OR] 4.03, confidence interval [95% CI] 1.12-14.53, P = .0460) and follow-up <6 months (OR 7.35, 95% CI 2.68-20.21, P = .0002) were associated with better outcomes.
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy is safe and effective in symptom resolution for biliary dyskinesia in children. Virgin abdomen and follow-up <6 months were associated with better outcomes. Prospective long-term studies comparing surgical and nonoperative management of biliary dyskinesia are required to determine the utility of cholecystectomy.
authors.affiliation: 1 Alberta Children's Hospital , Calgary, Alberta, Canada .|2 Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Lai
authors.affiliation: 2 Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Rothenberg
authors.affiliation: 2 Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Saundra M
authors.initials: SM
authors.lastname: Kay
authors.affiliation: 2 Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Kristin E
authors.initials: KE
authors.lastname: Shipman
authors.affiliation: 2 Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Slater
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001657:Biliary Dyskinesia / Q000601:surgery*; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: biliary dyskinesia; cholecystectomy; laparoscopy; pediatric