A comparison of cholecystectomy and observation in children with biliary dyskinesia.

PURPOSE: The success rate of ameliorating the preoperative symptoms of biliary dyskinesia in a pediatric population has been reported to be approximately 80%. The purpose of this study was to identify patient characteristics that may help to predict successful clinical outcomes in pediatric patients with biliary dyskinesia by comparing 2 groups of pediatric patients: those who underwent cholecystectomy and those who received no surgical intervention (control group).

METHODS: The medical charts of pediatric patients who had an ejection fraction of less than 35% and no other identifiable abnormalities revealed on diagnostic testing were retrospectively reviewed. Information regarding psychological diagnoses/treatment, diagnostic examination findings, histologic findings, and outcomes were collected. Patients were evaluated at 1 month and 2 years postoperatively.

RESULTS: From 1995 through 2003, 55 pediatric patients were identified. All patients had an abnormal ejection fraction on hepatobiliary iminodiacetic acid scan. The patients were divided into 2 groups: those who underwent cholecystectomy (n = 35) and a control group who did not receive surgical intervention (n = 20). Of those who underwent cholecystectomy, 74% improved, whereas 75% of the control group showed improvement after 2 years. Of all patient characteristics evaluated, only weight loss was found to be significant for determining patient outcomes.

CONCLUSION: When followed for a long enough period of time, outcomes were similar between the 2 groups. Of the patients whose symptoms improved, those who underwent cholecystectomy had a quicker resolution of abdominal pain than those who did not undergo surgery. With the exception of weight loss, none of the patient characteristics evaluated in this study proved to be statistically significant for predicting a positive outcome.